P - 76373REQUEST FOR ELECTRICAL INSPECTION ��` ;.
2•ro O 2�_ 6� 2 � Minnesota Board of Electricity `�
' 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� (651)642-0800TTY/MRS1-800-627-3529www.electricity.state.mn.us
Describe -using the back of th hite copy if necessary - the work covered by this request:
0��� I ` J
' E L FEES Outdoor Li hting Standard @$1
SERVICES / PUWER SUPPLIES Traffic S' nal Standard $5
0 to 400 Ampere $25 Supplemental Fee $20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Am ere $75 Transformers over 10 KVA $ 20
CIRCUITS I FEEDERS Transformer I Power Su I for Si ns I Outline Li htin $5
0 to 200 Am re $5 V NE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s $20
Each S stem Device or Ap aratus $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee $20
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE
3 to 12 Units @$5o Per Unit (minimum total fee is $20) �-�
Each Additional Unit @ $25 *NisarsEnFaemsa�cTOrzus �r
OTHER ADDITIONAL FEES
Lighting Retrofd na $.25 per Fixture I hereby certiry Nat I inspeded the eledncal installation descnbed herein on ihe dates slated:
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Special Inspection $30 per Hour `""""°'""°"°°""° °"" I
Special Inspection @ $.31 per Miie
THISJNS�A►LLATION MAY BE ORDERED DISCONNECTED.IF.NOT-COMPLETEO. W1THW.12 MONTHS
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Date: Rou h-in Ins ion R uired?
"� g pect' eq ❑Yes No Inspection Other Than Rough-In: ❑ Ready Now Will Call
�� t� -7 ��� You must call the inspector when ready! Date Ready:
I certify that I am the�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Stte Street Address City
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� Mailing Address
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NE
'o in7m g Install
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License
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Master ElecUician or Power Limited Technician -�
License Number
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