P - 76550REQUEST FOR ELECTRICAL INSPECTION ��'�,
1 934 104 � - � �� �
� � ❑ Minnesota Board of Electricity k
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104 ���
(651)642-0800TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us �
Describe -using the back of jhe white copy 'rf nec.�ssary - the work covered by this request:
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GENER4L FEES Outdoor Liahtina Standard (� $1
SERVICES / POWER SUPPLIES
0 to 400 Ampere $25
401 to 800 Am ere $50
Above 800 Am ere $75
' IRCUITS I FEEDERS
0 to 200 Am ere $5
Abave 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 V6LTS
Each S stem Device or Apparatus $.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Li htin Retrofit $.25 per Fi�ure
Center Pivot Irri ation Boom $40
Manufactured Home Park Lots C� $25
Special Ins ection $30 per Hour
Special Inspection $.3t r Mile
THIS INSTALLATION MAY BE ORDERED I
I IIII I) III II III II III I) III II III (I II) II (II II � I�
19341049
Supplemental Fee $20
Transformers u to 10 KVA $10 I C B D
Transformers over 10 KVA a$ 20
Transformer / 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 a$20
Investi ative Fee
Reins ection Fee a $20
TOTAL FEE �/�/�Q
(minimum total fee is $20) %
I hereby cert'rfy that I inspeded Ne electrical installation described herein on the dates stated:
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E%PIREDIFd4NDONED DATE
CTED IF NOT COMPLETED WITHIN 12 MONTHS
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Rough-in Inspection Required? ❑ Yes �o Inspection Other Than Rough-In: ❑ Ready No ill Call �
/�� �'��/ You must call the inspector when ready! Date Ready: /� .G �
I certify that I am the �Cf�CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby_ est inspection of the electrical work at
Job Site Street Address
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DN BACK OF YELLOW COPY
secnon Kange Fi2 No.
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Electrical Utildy Address
Contrador License Number
r Perfortning Installation)
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� OAR F ELECTRICIN COPY
Area
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Master Electrician or Power
License Number
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