P - 75807a REQUEST FOR ELECTRICAL INSPECTION
1��� v-12 6 1� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
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(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
Describe -using the back of the whfte copy'rf necessary - the ork covered by this request:
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GENERAL FEES Outdoor Lighting Standard an. $1
VICES I POWER SUPPLIES
0 to 400 Am re @$25
401 to 800 Ampere @ $50
Abave 800 Ampere @ $75
:UITS / FEEDERS
0 to 2�0 Ampere @ $5
Above 200 Ampere @$10
�M, COMMUNICATION, REMOTE CONTROL, SIG
:F11TS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
TIFAMILY DWELLINGS (PER UNIn
3 to 12 Units aQ $50 Per Unit
Each Addi�onat Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irriaation Boom C� $40
S ial Inspection @$30 r Hour
Special Inspection @ $.31 per Mile
THIS INSTALLATION MAY BE ORDEREI
IIuI If I�1 IIII� III� Iflll (IIII IIUI II�II II III III�I
1778126?�
Traffic
Transformers u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer / Power Su I for Si ns I OuUine Li hfin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circufts and Two Inspection Trips Each Dwelling Unft @$80
Additional Ins ction Tri s@$20
Investigative Fee
Reinspection Fee @ $20
TOTAL FEE
(minimum total fee is $20) ��
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I hereby cerfi(y that I inspeded the electrical installafinn d�cribed herein on the datas ste�:
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iCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS _—I
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1d1'' Rough-in Inspection Required7 ❑Yes �No Inspectlon Other Than Rough-In:�Ready Now OVdill Ca0
1 Q�12-�5 You must call the inspector when readyl Date Ready:
I csrtify that I am the [XLICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electripl work at
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BOARD OF ELECTRICITV COPV
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