P - 77478REQUEST FOR ELECTRiCAL INSPECTION `
1-787-911 5 y ���`_ .
Minnesota Board of Electricit �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �. �.
(651) 642-0800 TTY/M RS 1-800-627-3529 www. electricitv. s�a�e. mn. us
Describe -using the back �f the white copy if ne�sia7�t=�the btprlc,tAYe�rgd.by�i� re�qu�st; �� �� ��.i��
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�-� GENERAL FEES Outdoor Lighting Standard @$1
SERVICES I POWER SUPPLIES Traffic Signai Standard @$5
0 to 400 Ampere $25 Supplemental Fee $20
401 to 800 Am ere $50 Transformers u to 10 KVA $10
Alwve 800 Am re $75 Transformers over 10 KVA $ 20
CkRCUiTS IFEEDERS Transformer I Power Su I for Si ns I Outline Li htin $5
0 to 200 Am ere $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 A re $10 Includes the Service andlor Power Supply up to 500 Amperes, All
NARM, 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 System Device or Apparatus $.50 Investigative Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee @$20
12 Units @ $50 Per Unit
� Additional Unit @ $25
OTHER ADDITIONAL
ting Retrofit @ $.25 per Fixture
ler Pivot Irtigation Boom @ $40
ufactured Home Park Lots @ $25
�eational Vehicle Park Sites a(� $5
Hour
TOTAL FEE � ft,
total fee is $201
I insoected the elecMcal installation descnbed herein on the dates stated:
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TH1S iNSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS _ ___�
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� �a�� 'I Rough-in Inspection Required? ❑Yes ��] No I Inspection Other Than Rough-In: QReady Now L� Will Call
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� � 3� � � �� '; You must call the inspector when ready! ! Date Ready:
I cerfify ihat I am the L�] LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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�OwnerlOccupant N'}ame - j Please Provide Two (2) Phone Numbers Including Area Code
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I,�Eladrical Utiliy I Electrical Utility Address
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IrContractoc / Company Name Contractor License Number '�. Master Electrician or Power Limited Technic
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' µ&{ing qddress (Contractor, Company or Owner Performin� Installation� . __ :.
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I yett�orized Si nai�ontracror or Owner Performing Installation) i Please Provide Two (2) Phone Numbers Including Area Code
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