P - 76268• REQIdEST FOR ELECTRICAL INSPECTION
1� J'� - 516 0 Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
' . (651) 642-OS00 TfY/MRS 1-800-627-3529 www.electricity.state.mta.us
Dascribe -using the back of the white copy ff necessary - the work covered by this request:
- E�CEL EhIEFiGY S�VE�i'S S�IT�aH
_ GENERAL FEES Outdoor Liah6na Standard l� $1
tf�, COM6NUNICATIQN, REMOTE CONTROL, SIGNAL
.UITS, CIR�UITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIQNS TO THE GENERAL FEES
fIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Addifional Unit @ $25
OTHER ADDITIONAL FEES
�i tin Retrofit @ $.25 per Fixture
Center Pivot Irriga6on Boom a$40
PdenufacWred Home Park Lots @ $25
Recreationa! Vehicle Park Sites $5
5e te Bondin Ins 'on $20
S ial Inspectian @$30 per Hour
Spedal Impection $.31 r Mile
S 1l+1STAI.LATIOAI MAY BE ORDERED
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Sup lemental Fee @ $20
Trensfortners u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer I Power Su I for Si ns I Outline Ughdn $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, Ali
Circufts and Two Inspection Trips Each Dsvelling Unft @$80
Addi�onal Ins 'on Tri s $20
Inves6gative Fee
Reins ction Fee @ $20
TOTALFEE
(minimum total fee is $ZO) g� �'��
rHis u�aFOa wsaECroa use oN�v
I hereby certify ihet l inspected the elecMcal insMallation desaibed herein on fhe dates stated:
5
IF NOT COMPLETED
REC"D JUN 14 200y
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°'p1D' Rough-in Inspection Required9 ❑ Yes �] No Inspection Other Than Rough-In: �Ready Idow ❑ Will Call
f?� ����� You must call the inspector when readyl Date Ready:
I c�rtify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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Eleetrical Utility Electricel UtiIRy Address
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ConVactor / Company Name Contrector Llcense Number Master Electrician or P
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Nlailing Address (Contractar, Company or Owner Performing Installadon)
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A�ulrfZ�d $1$rtatura (Cantractor or Owner Perfortning Installation) Please Provide Two (2) Phone Numbers I
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