P - 77296REQUEST FOR ELECTRICAL INSPECTION a'��`��`�
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I 1�� Q, � a� � 8 4, � 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.staJe.mn.us �;;�i�
Describe -using the back of th white copy if necessary - the work covered by this request: �
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GENERAL FEES Outdoor Li htin Standard @$1
SERVICES I POWER SUPPLIES Traffic Signal Standard $5
0 to 400 Ampere @$25 Suoolemental Fee (� $20
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus a$.50
ADDITIONS TO THE GENERAL I
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit an, $25
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irrigation Boom @ $4(
Manufactured Home Park Lots l� $
� Transformer / Power Supply for Signs / Outiine Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
Investiqative Fee
TOTALFEE
total fee is $20) ��
I hereby cerliTy that I inspected the electrical installation described herein on the dates stated:
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S ial Ins ion $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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18420844
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uaie: Rough-in Inspection Required? ❑ Yes �Jo Inspection Other Than Rough-In: ❑ Ready Now�ill Call
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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 SVeet Address ���y
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Township Secti Range Fire No. County
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(Contractor, C y �
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Address
Contrador License Number Master ElecGician or P�
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Nlease Prov�Ae Two (2) Phone Numbers Including Area
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