P - 77695REQUEST FOR ELECTRICAL INSPECTION ��
I Q% Q 1 Minnesota Board of Electricity :��` /
1��J j V'� �� 1 �' 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �'
(651)642-OSOOTTY/MRS 1-800-627-3529 www.electricity.state.mn.us ;"�
Describe -using the bac e whi copy if necessary - the work�gve�ed by this request: /
I SERVICES /
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofit $.25 per Fixture
Center Pivot Irrioation Boom (� $40
Tra�c Signal Standard $5 '
Supplemental Fee $20
Transiormers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns / Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Insoection Trios l�a $20
TOTAL FEE
total fee is $201
I hereby certify that I inspeded the electrical installation described herein on the dates stated: �
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites $5 w�saecr�oN oare
Se arate Bondi Ins ion $20 �— 7��
Special Inspection $30 per Hour E"'R�'"a�`"°°"EO pA�
Special Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS ____
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' Date: Rou h-in Ins ection Re uired?
/�r g p q ❑ Yes ❑ No Inspection Other Than Rough-In: eady Now 0 W ill Call
!�� �� O You must call the inspector when ready! Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY p OWNER and hereby request inspection of the electrical work at:
Job Site SVeet Addre
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INSTRUCTIONS ON BAGK OF
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MN 55433
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