P - 77423REQUEST FOR ELECTRICA INSPECTION T�`�
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� Minnesota Board of Electricity �0�. ���ZJ�' k ,:�„
1821 University Avenue Suite 5-128, Saint au , mnesota 5�dd �.
(651)642-OSOOTTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Descnbe -using thepack of the�white copy if nece�ary -�e wor�.covered by this request:
SERVICES / POWER SUPPLIES
0 to 400 Ampere @ $25 �
401 to 800 Am re $50
Above 800 Ampere $75
CIRCUITS / FEEDERS
0 to 200 Am ere $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lightin Retrofit @ $.25 per Fi�ure
Center Pivot Irriaation Boom (� $40
Special Inspection a$30 per Hour
Special Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED
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18628834
Outdoor
Supplemental Fee $20
Transformers u to 10 KVA $10
Transformers over t0 KVA a$ 20
Transformer / 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
TOTALFEE
total fee is $20) �� `
I hereby certiry that I inspected the eledrical installation described herein on ihe dates stated:
IF NOT COMPLETED WITHI
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Rough-in Inspection Required? ❑Yes ]�No Inspection OtherThan Rough-In:�Ready Now ❑Will Call
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g� 7' �s You must call the inspector when ready! Date Ready: ���
I certity that I am the J�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Sde Street Address
� 70 �'OiG� D� Si �i� cfi�/1�
Township Section Range Fire No. Coun y
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Owner/Occupant Name Please Provide Two (2) Phone Numbers Including Area Code
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ador / Company Name
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ig Address (Contrador, Company or Owner F
7a � 7 UNI(1FI15r
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Contrador License Nui
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INSTRUCTIONS ON BACK YELLOW COPY BOARD OF ELECTRICITY COPY
ber Master Electrician or Power Limited Technician
; License Numq� y�,��� � /}�
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�rovi Two (2) Phone Numbers Including Area Code
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