P - 77361� REQUEST FOR ELECTRIC L INSPECTION
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1V ❑ Minnesota Board of Electricit �
1821 University Avenue Suite S 128, Saint Paul, Minnesota 55104
�e -using the back of the wl
GENI
CES I POWER SUPPLIES
fo 400 Ampere @ $25
)1 to 800 Ampere @ $50
bove 800 Ampere @ $75
ITSlFEEDERS
to 200 Ampere Ca? $5
(651) 642-0800 TTY/MRS 1-800-627-3529 www.eleclrrcity.stute.mn.us
copy if neceSSa[V.��e eintk,�WPded,by��teouest. S SW j f�H
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�L FEES Outdoor Lighting Standard @ $1
Traffic Signal Standard @ $5
Supplemental Fee @ $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns I Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
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 $20
Each System Device or Apparatus @$.50 Investigative Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee @$20
TIFAMILY DWELLINGS
3 to 12 Units @$50 Per
Each Additional Unit @ ;
Retrofit @ �.25 per Fixture
'ivot Irriaation Boom (c� $4(
I hereby certify ihat I
i�iA�ret Zd.✓��i
total fee is $20)
the elecirical installation descnbed herein on ihe dates stated:
-��
Special Ins ction @$.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS __
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� ��ii � I U� I Rough-in Inspection Required? ❑ Yes �] No �i, Inspection Other Than Rough-In: [�Ready Now L� Will Call
'�� 1 You musl call Ihe inspector when ready! �! Date Ready:
I certify that I am the 'L�I LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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Range
NEf�GY
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County
(2) Phone Numbers Including
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���Q���G COF�F'O�{ATION '�Con�ractor�se�ll��� MasterElectricianorPowerLimitedTechnician
License Number
'ess Contractor Company or Owner Performin Installation) ��
TE�F:F;IT�IRIAL �;OAL�, 5�11�hIT f'AUL, MN 5�,11�
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' t (ConUactor or Owner Performmg�lnstallation) ���pa�e�Pro�i����F�h�ne � mbers Including Area Code I
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