P - 75950s� REQUEST FOR ELECTRICAL INSPECTION -��°
2 ° � � =p ° � � 7 � Minnesota Board of Electricity
1821 University Avenue Sufte S-128, Saint Paul, Minnesota 55104
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� " (651) 642-0800TTY/MRS 1-800-627-3529 www.edectricdty.state.mn.us �" "�
Describe -usi�n ttte back of tha whfte copy'rf necessary - the work covere�i by this request:
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GENERAL FEES Outdoor Lighting Standard @$1
SERVICES / POWER SUPPLIES �. �: . Traffic Siunal Standard C� $5 _
woove uuu am re m��5 Transfomrers rner 10 KVA $ 20
GI CURS / FEEDERS Transfomrer / Power Su I for Sf ns / Outline Li tin $5
0 to 20Q Am re$5 ONE & TWO FAMILY DWELLINGS, EACH UNR
Above 200 Am re $10 Includes the Service and/or Power Supply up to 500 Amperes, M
ALARM, COMMUNICATION, REMOTE COMROL, SIGNALING Ciraiits and Two InspecUon Trips Each Dwe�ing Unit @$BD
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additlonal Ins 'on Tri $20
Each S em Device or Apparatus @$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Rei� 'on F� @$20
MULTIFAMILY DWELLINGS PER UN TOTAL FEE ,�i
3 to 12 units �$50 Per Un(t (minimum total fee is $20) �� S�V
Each Addtlonal Unit @ $25 T�s^��°'�sPE�Taeu�ow.Y
OTHER ADDITIONAL FEES
ughting Retrofit @$25 r Fad,re i nereby certty n,at I�aed me e�ca� tr��anon aesc��d nerea, on me aa�es smmd:
Center Pivot Ir�gation Boom @$40 �" w onre
Manufactured Home Park Lots $25 �% —/ % �
Reaeabonal Vehicle Park Sites $5 �TM^� °'�fON ��
Se Bondin I� 'on $20 -- - : - - - - - - — �
S al I� 'on Q$30 r Hour °�0/ ��
S' Irrs on @$.31 r Mfle
THIS tNS�ALLA'EIQNdIAAY.BE�ORDEREQ�ISCQN(aIEECTED IF NOT COMPLE�ED=W1TkUN �� 611ON�S, _.-, .. --
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��( � � g pecUon R uired? (�Yes ❑ No Inspectlon Other Than Rough-In: 0 Reaay Now�Witl CaII
You must call the inspector when readyl Date Ready.
I certiiy that I am the 0 LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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OwnedOcwpaM Neme Please Provide (2) Phone Numbers IncludU�g Area Code
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Auth naNre ( o r or Qwnar o ing Insfallatlon) Please Provide Two (2) Phorre Numbers Including Area Code
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