P - 77060REQUEST FOR ELECTRICAL INSPECTION ��Y��'$��
1� Q��� O� Q a Minnesota Board of Electricity - ` � �
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
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(651)642-0800TTY/MRS1-800-627-3529www.electriciry.state.mn.us �;��
Describe -using the back of the white copy if necessary - the work overed by this requ st: c �.
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GENERAL FEES Outdoor Lighting Standard @$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Ampere $25 Supplemental Fee $20
401 to 800 Amoere (� $50 Transfortners uo to 10 KVA a(� $10
Above 800 Am ere $75
CIRCUITS / FEEDERS
0 to 200 Am re $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus an $.50
3 to 12 Units @$50 Per Unit
Each Add'Rional Unit @ $25
OTHER ADDITI01
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irriqation Boom C� $40
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins ection Tri s $20
Investigative Fee
Reins ction Fee $20
TOTALFEE
(minimum total fee is $20)
THISFRFAFORINSPECTORUSEONLV �0,�
I hereby certify Nat I inspeded ihe electrical installation described herein on the dates stated:
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S ecial Ins ction $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Date: Rough-in Inspection Required? ❑ Yes �Jo Inspection Other Than Rough-In:� Ready Now ❑Will Call
( d �� 0^ y s You musl call the inspector when ready! Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby reques � °'of the electrical work ai
Job SRe SVeet Address �
73�10 ConCe�^To C ve /� c� e
Township Section Range Fire No. ou ty
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Owner/ ccupant Name � Please Provide T () Phone Numbers Inciuding Area Code
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Electrical Utility Electncal Utility Address
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� Contrador License Number Master Electrician or Power Limited Technician
� �� � O � License Number
n Performing Installation)
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� rformi I Ilation) Please Provide Two (2) Phone Nyrnbers Including Area Code
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