P - 77537REQUEST FOR ELECTRICAL INSP�.CTION �
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1� Q� o� 4 8 3� Minnesota Board of Electricity �/Lrl� ����� � ?� ,
1821 University Avenue Suite S-128, Saint au�5��nneso a 1 4 �'
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us ?�*.�
Describe -using the back of ihe white copy if necessary - the work c4vered by this request:
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GENERAL FEES Outdoor L' htin Standard @$1
SERVICES I POWER SUPPLIES Traffic Signal Standard $5
0 to 400 Ampere $25 Su plemental Fee $20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Am re $75 Transformers over 10 KVA $ 20
CIRCUITS I FEEDERS Transformer / Power Su I for Si ns / Outline Li htin $5
0 to 200 Am re$5 ONE & 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 CANTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s $20
Each S stem Device or Ap aratus $.50 Investigative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee $20
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE
3 to 12 units @$50 Per unit (minimum total fee is $20) ,��
I TH
Li Mif1 Retroflt $25 pCf FlXture liiereby certify that I inspeded the elec[rical installation described herein on the dates stated:
Center Pivot Irri ation Boom @$40 Ro°c"'" _ 7oATE �
Manufactured Home Park Lots $25 �"� �
Recreational Vehi�e Park Sites (� $5 Firui iNSVecTion DATE
@ $.31 per Mile �
TION MAY BE ORDERED
IF NOT COMPLETED WITHI
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18204834
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Date: Rough-in Inspedion Required? �es ❑ No Inspection Other Than Rough-In: ❑ Ready Now �ta4Gill Call
�/ � �� 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 Site Street Address ��Y
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Township Section Range Fire No. County
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OwnedOccupant Name Please Provide Two (2) hone Numbers Induding Area Code
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or Owner F
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Contractor
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Master Eledrician or Power
License Number
Please Provide Two (2) Phone Numbers Inclutling Area Gotle
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EB-00001A-15 8.1