P - 77611REQUEST FOR ELECTR�J AL I SP C�T/ION �`�'�
1� C� 4 1�'�" �� 1� Minnesota Board of Electricity :�S �� -� �C7 02� k �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �'
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Desc 'be -using the back of the white copy if necessary - the�ork cover by this request:
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GEN L FEES Outdoor Lightin Standard @$1
SERVICES / POWER SUPPLIES Traffc Signal Standard $5
0 to 400 Ampere $25 Supplemental Fee $20
401 to 800 Am ere $50 Transformers u to 10 KVA $10
Above 800 Am ere $75 Transformers over 10 KVA $ 20
CIRCUITS I fEEDERS Transfortnerl Power Su I for Si ns I OuUine Li htin $5
0 to 200 Am ere $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 CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional ins ection Tri s $20
Each S stem Device or Apparatus @$.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) �� -�J
Each Addflional Unit @$25 THIS AREA FOR INSPECTOR USE ONLY
OTHER ADDITIONAL FEES
Lightin RBtfOflt $25 p2f Fi�ctufB I hereby certify that I inspected the electriral insiallation described herein on the dates stated:
Center Pivot Irti ation Boom $40 R°"c�'" o"TE
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites $5 F'w,��"�c.�a, oATE
Se arate Bondin Ins ction $20 - �"t--"�-- � - � -�'�
S iai Inspection @$30 per Hour E%RRE01A94NDONED oa�
S cial Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Date: Rou h-in Ins ction Re uired? ❑ Yes ❑ No Ins
� g pe q pection Other Than Rough-In: ❑ Ready Now ill Call
U�/� / 1,��� 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 ai
Job SRe SVeet Addr City
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Township Section Range Fire No. County
ccupant rvame Piease Provide Two (2) Phone Numbers InGuding Area (
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Utility • Electrical Utility Address
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,ddress (Contrador, C pany �o '"ner Perfortnin Installatjon)
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