P - 76060REQUEST FOR ELECTRICAL INSPECTION
1� 7 8 7� � 8 4, � Minnesota Board of Electricity _
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
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Fee @ $20
upto10KVA@$10
over 10 KVA ld $ 20
20D Am $10 Includes the Service andlor Povaer Supply up to 500 Amperes, All
1A1DAUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unft @$80
CIRCUITS OF LESS iNAN 50 VOLTS Additlonal Ins ction Tri $20
i m Devit;e or A paratus @$.50 Investiga6ve Fse
ADDITIONS TO THE GENERAL FEES Reinspection Fee @$20
ILY DVdELLINGS PER UNI TOTAL FEE �- «
! Units �$50 Per Unit (minimum total fee is $20)
ldditipnal URit� $25 TN�g��FORMSPEGTORUSEONLY
OTHER ADDITIONAL FEES
Retrofit @$25 per Fixture I hereby certify Nat I inspected the electrical inslallafion described herein on ihe dates steted:
• Pivot IrriQation Boom (a� $40 aouc„ w oa�
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'�I Inspection @ $.31 per Mile
TM18 iRl$TALLATFOW MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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� ��� - Rough-in Inspection Required? ❑ Yes� �] No Inspection Other Than Rough-In: �2eady Now ❑ Will Call
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You must qll the inspector when readyt Date Ready:
I certify that I am the LJ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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OHrt�ar/Occupant Name Please Provide Tvro (2) Phone Numbers Including Area Code
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Electrical Utility Electripl Utllity Address
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Cnntractnr / Company Name Contractor Li�nse Number Master Electrician or Pourer LimHed Technician
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AtRhmized 8 ture (ConVactor or Ovmer Performing Installation) Please Provide Two (2) Phone Numbers Including Area Code
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