P - 77702REQUEST FOR ELECTRICAL INSPECTION ����
� 1_$3 g� g 2 g� Minnesota Board of Electricity �-- :�
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �'
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Li hting Standard @$1
SERVICES / POWER SUPPLIES Traffic Signal Standard @$5
0 to 400 Ampere $25 '� Su lemental Fee $20
401 to 800 Am ere $50 Transformers u to 10 KVA $10
Above 800 Am re $75 Transfortners over 10 KVA $ 20
CIRCUITS / 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 ere $10 Includes the Service andlor 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 Addftional Ins ction Trips $20
Each System Device or A 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)
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofrt $.25 per Fixture
Center Pivot Irriaation Boom (� S40
I hereby certify that I inspeded the electrical installation desaibed herein on the dates stated:
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Se arate Bondin Ins tion $20 <,,,^,.._,__.,�--� Z.� � /G - 7 O-`j�
SpeCial I�SpeCtlon $30 f Houf �Piaeo�aannoorueo pA�
Speciai Inspection $.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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18399295
/� Rough-in Inspection Required? ❑Yes � Inspection OtherThan Rough-In�Ready Now ❑Will Call
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L You must call the inspec[or when ready! Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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Company or Owner
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Utildy Address
Contrador License Number Master ElecVician or Power Limited Technician
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wn racwr or vwner renvrmmg mscananon� wease Prov�de Two (2) Phone Numbers Including Area Code
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OP YELLOW COPY BOARD OF ELECTRIGTY COPV FR-00001A.15 n��nne