P - 77019REQUEST FOR ELECTRICAL INSPECTION ��'�
� e � � � �p � � � � Minnesota Board of Electricity �')v ( .. ��� � � �
1821 University Avenue Suite S-128, Sainf�au��Minne a 1 4 �,
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us �
) cribe -using the back of the whfte copy if necessary - the /w�ork covered by this request: �— � ,+
,'�. ',�, i: j GQ U�cre I dl' : �CG�'� %�� Cc�! 2�.+' ��F� �' S"�Zt�/�'! '
GENERAL FEES Outdoor Li ' andard @$1
iERVICES / POWER SUPPLIES � Traffic Sianal Standard (� $5
CIRCUITS / FEEDERS
0 to 200 Am ere a$5
Above 200 Am ere a$10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Ao�aratus na $.50
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
Lighting Retrofd @ $25 per Fixture
Center Pivot Irzi4ation Boom Cc� $40
Special Inspection $.31 per Mile
THIS INSTALLATION MAY BE
11II IIIII 111II IIIII I III Iffll IIIII IIIII �� II�
18476853
Transformers u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer I Power Supply for Signs / Outline Lighting @$5
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
TOTALFEE 2�,
total fee is $20) J(,J .,��'
I inspected the electrical installation described herein on ihe dates slated: �
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APLETED WITHIN 12 MONTHS J
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Date: Rou h-in Inspection Re uired?
g q ❑ Yes ❑ No inspection Other Than Rough-In: eady Now ❑ Will Call
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�� �—" � 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
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