P - 77626_ REQUEST FOR ELECTRIC�L INSPECTION `��'�'
Minnesota Board of Electricity �� o �s Q1 �'� ��
1� 8 8 1_ 3 O 7 a 2' niversity Avenue Suite S-128, Saint Paul, Minnesota 55104 �-_�'
6 1) 2-0800TTY/MRS1-800-627-3529`wwlv.electricity.stale.mn.us �-;�a��
Describe -using thelb�� i the white co if n� ,�Oe wq�jc�oCered by this request:
%lY AI
SERVICES / POWER SUPPLIES
0 to 400 Ampere @ $25
401 to 800 Am re $50
Above 800 Am ere $75
IRCUITS / FEEDERS
0 to 200 Am re $5
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 Fi�ure
Center Pivot irrigation Boom @ $40
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites (cil $5
Outdoor Lighting Standard @ $t
Traffic Si nal Standard $5
Supplemental Fee $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns I Outline Li htin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins ection Tri s $20
Investi ative Fee
Reinspection Fee $20
TOTALFEE `
(minimum total fee is $201 .
I hereby certiy that I inspected the electrical installation described herein on the dates stated: �
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Special Inspection @ $30 per Hour `""'"`°'"°""°""`" """ (
Special Inspection @ $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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1881307L
la��/'`(.��� Rough-inlnspectionRequired? ❑Ye{ ONe� Inspection
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« � You must call the inspector when ready! Date Reac
I certify that I am the �I�I LICENSED CONTRACTOR ❑ COMP�NY ❑ OWNER and
Job Site SkeetAdd � .. e i
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Now ❑WiIlCall
request inspection of the electrical work at
: Section Range Fire No. C
� Ple e Provide Twc
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�ectrical Utilitv Address
! Co`t�ctor iceis� u�� Master ElecVician or Power Limited Technician
License Number
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