P - 77474REQUEST FOR ELECTRICAL INSPECTION
� �� Q � Q � � � � � Minnesota Board of Electricity _._ �; � � �
J V 1821 University Avenue Suite S-128, Saint P ' neso`f� 55104
(651)642-0800TTYIMRS 1-800-627-3529 ww�2�tric' .state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request: uv G s � j'/�� v v''i'-
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,. GENERAL FEES Outdoor Lighting Standard $1
SERVICES I POWER SUPPLIES Traffic Sipnal Standard (a� $5
401 to 800 Am ere a$50
Above 800 Am re $75
CIRCUITS I FEEDERS
0 to 200 Am re . C"�i
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALI
CIRCUtTS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem 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
Li htin Retrofit $.25 per Fixture
Center Pivot Irri ation Boom $40
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites $5
Se arate Bondin Ins tion $20
Special Inspection $30 per Hour
Special Inspection $.31 er Mile
THIS INSTALLATION MAY BE ORDERED
IIIII IIIII IIIII II III III�I I) III IIII) III� II� IAII
19383496
� Transfortner / Power Supply for Signs / Outline Lighting @$5
ONE & 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
TOTAI FEE ^�
total fee is $20) 4� �% ` ��—
I herebv cer�N thal I inspeded the elecVical insfalla6on desaibed herein on the dates stated: �
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:TED IF NOT COMPLETED WITHIN 12 MONTHS
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Date: Rough-in Inspection Required7 ❑ Yes �Olo Inspection OtF�er Than Rough-In: �,(teady Now ❑ Will Call
�" �{p '� Q You must call the inspector when ready! Date Ready: ���J -�/�j
I certify that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical worlc at
Job Si[e Street Address �RY
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Township Section Range Fire No. County
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Owner/Oaxipant Name Please Provide Two (2) Phone Numbers Induding Area Code
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Electncal Utility Electrical UtlIRy Address
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Compa r Owner Pei
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ConVactor License Number nnaster tiecmGan or rower umrtea i ecnmaan
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Please Provide Two (2) Phane Numbers Induding Area Code
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CTRICINCOPY EB-00001A-15 8.1.2004