P - 77475REQUEST FOR ELECTRICAL INSPECTION
2� O��. � O 3 7 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�� (651) 642-0800 TTY/MRS 1-800-6273529 www.electricity.state.mn.us
Describe -using the back of the white wpy'rf necessary - the work covered by this request:
'� l�vb C(a us�n �5l 1I ��-7S�ir5'
0 to 400 Ai
401 to 800
0 to 200 Ampere @$5 !,c/ 1( e t
Above 200 Ampere @$10
tM, COMMUNICATION, REMOTE CONTROL,
;UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL F
TIFAMILY DWELLINGS (PER UNI�
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
� Retrofit @ $.25 per Fi�
Pivot Irrigation Boom �
ctured Home Park Lots
Outdoor Lighting Standard @ $t
Traffic Si nal Standard a$5
Supplemental Fee a $20
Transformers u to 10 KVA $10
Transiortners over 10 KVA $ 20
Transformer / Power Su I for Si ns I Outline Li htin $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
Addftional Inspection Trips @ $20
Investiaative Fee
TOTAL FEE
total fee is $20)
I inspecled the electrical inslallation described herein on the dates stated:
SeVarate Bondi Ins tion $20 L--"'� �"" � � � ' ` �
Special inspection $30 per Hour ExamEOina4NOOnEO o^�
Special Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS _ �___
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�?OB1037� ��'�'�'U�_�IL
Date: Rough-in Inspection Required? ❑Yes (�Oo Inspection OtherThan Rough-In: ❑ Ready No�Nill Call
/�—� �(..ip You must call the inspector when ready! Date Ready:
I cerfify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at