P - 77500REQUEST FOR ELECTRICAL INSPECTION �
1� 1 v 1- 9 0 9 9❑ Minnesota Board of Electricity ;�-
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �'
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricltv.state.mn.us
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' GENERALFEES
Outdoor Lighting Standard
Traffic Siqnal Standard na '
avu Am re cu �5u Transformers u to 10 KVA $10
800 Am re $75 Transformers over 10 KVA $ 20
FEEDERS Transformer 1 Power Su I for Si ns I Outline Li htin $5
D Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
200 Am re $10 Includes the Service andlor Power Supply up to 500 Amperes, All
MMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL I
PdULTIFAbIILY DWELLINGS PER UNIT
3 to 12 Uni4s @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Li htin Retrofit $25 per Fixture
Center Pivot Irrigation Boom @ $40
AAanufaciured Home Park Lots (o� $25
Reinspection Fee @ $20
TOTAL FEE 1 (}, �,(}
(minimum total fee is $20)
1'HIS ARE4 FOR INSPECTOR USE ONLV
I hereby certify that I inspected the electrical installation described herein on the dates stated:
S teBondin Inspection $20 a �-07
Sp6Ci21 Insp0Cti0� $30 pB� HOU� exaieeo ne�r,soNec oare
S ciai Ins ction @$.31 per Mile
TMiS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 72 MONTHS
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a'�. I Rou h-in Ins ection Re uired?
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9 p q ❑ Yes 7�] No ' Inspection Other Than Rough-In: [�Ready Now ❑ Will Call
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I certify that I am the 0 LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER
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, Job Site Street Address
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and hereby request inspection of the electrical work at:
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i OwneriOccupant Name - Please Provide Two (2) Phone Numbers Including Area Code
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ElecMcal Utility - �Electrical UtilityAddress � � ,
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I C ton�ractor / Company Name � � Contractor License Number � Master Electrician or Power Limited Technician ��
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ti!?`{ �' ,� [ E � t: € €J� - � �� r� �„1�� `. f�i �; , I License Number
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. MarLng Address (Conhactor, Company or Owner Performing Installation) ��
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, Authoriz�d S' nature (Contractor or Owner Performing Installation) - �i Please Provide Two (2) Phone Numbers Including Area Code �
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IItlSTRUCTIONS ON BACK OF YELLOW COPY BOARD Of ELECTRICITV COPY Fa_nnnn� e_�c c, ���.