P - 76476REQUEST FOR ELECTRICAL INSPECTION �
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� � � � � 5 � � 3 3 � Minnesota Board of Electricity �. � ��
�., .,� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
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(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us ,
Describe -using the back ef the white copy if necessary - the ork covered by this request:
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G RAL FEES Outdoor Liohtina Standard na S1
I SERVICES I POWER
Above 200 Am ere a$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or aratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Traffic Siqnal Standard
Transformers over 10 KVA $ 20
Transformer / Power Supply for Signs I Outline Lightinq .$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
Additional Inspection Trios C� $20
TOTAL FEE �
(minimum total fee is $20) �Q -�r
U hting Retrofit $.25 per Fixture I hereby certify that I inspected the elecVical installffiion desaibed herein on the dates sfated:
Center Pivot Irri ation Boom $40 RWGHIN ` oq,�
Manufactured Home Park Lots $25 / l 3d ' G`
Recreational Vehicle Park Sites $5 � F �NSPecT�oN oA.E
Se arate Bondin Ins ction $20 � /` —��07
Sp2C121 IOSp�100 $30 p8� HOU� exaiaeornannoorJeo opTE
Special Inspection $.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Date: Rou h-in Ins ection R uired?
g p eq ,;�Yes ❑ No Inspection Other Than Raugh-In: ❑ Ready Now�ill Call
You must call the inspector when ready! Date Ready:
I certify that I am the�LICENSED CONTRACTOR ❑ COMPANY O OWNER and hereby request inspection of the electrical work at
or
Range
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Niease Provltle Two (2) Phone Numbers Including
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License Number I Master Electrician or
,� _ / / _ , �7 License Number
or ertorming_ Installation) Please Provide Two (2) Phone Numbers
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I BOARD OF ELECTRICIN COPY
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