P - 77310REQUEST FOR ELECTRICAL INSPECTION y���'����
1����� 14 3 2 Minnesota Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 `�����
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(651) 642-0800 TTYIMRS 1-800-627-3529 wH�x�.elec�ricity.state.mn.us '�;�
Describe -using the back of the white copy if necessary - the work covered by this reques .
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GENERAL FEES Outdoor Li htin Standard $1
SERVICES I POWER SUPPLIES Traffic Sianal Standard (a� $5
Above 200 Am ere a$10
ALARM, COMMUNICATION, REMOTE CANTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus $.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Li htin Retrofit $25 per Fixture
Center Pivot Irriaation Boom na $40
Supplemental Fee $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns / Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Add'Aional Ins ion Tri s $20
Investi ative Fee
Reins ction Fee $20
TOTAL FEE
(minimum total fee is $20) Z D_�'
I hereby certi(y that I inspeded the elecUical installation descnbed herein on the dates stated: �
Special Inspection $30 per Hour ��REO��,NOO�o
S'al Ins on $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONT
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Rough-in Inspection Required? ❑Yes �No Inspection Other Than Rough-In: �Ready Now 0 Will Call
�l�3 D�/ You must call the inspector when ready! Date Ready: 6�'� f 0`r
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Address ��y �
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r / Companv Name
� Mailing
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any or Owner Performing Installation)
or Owner,Performi q nst a onf 1
Please Provitle 7wo (2) Phone Numbers Including Area
dr4;) 7 6-�a3( )
License Number Master Eledrician or Power Limited 7
, _ License Number
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Numbers InGuding
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EB-0000