P - 82469REQUEST FOR ELECTRICAL INSPECTION ��GjO
��� �� Minnesota Board of Electricity �
������ g 4� � � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104�
� � ��°�"; (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us
Identify the work coveretl by this request: (_ �� C` �
❑NEW MODEL ❑ADDITION ❑REPAIR
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GENERAL FEES Outdoor Li htin Standard C� i
SERVICES / POWER SUPPLIES Trattic Si nal Standard �$5
0 to 400 Am ere (� $25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS �. Transformer I Power Su I for Si ns / Outline Li htin �$5
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units (� $50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 er Fixture
Center Pivot Irriaation Boom � $40
� $30 per Hour
� 5.31 cer Mile
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin UnR �$8(
Addilional Ins ection Tri s�$20
Investi ative Fee
Reinscection Fee (� $20
total fee is
�d Me eleclriql instaqation described herein on the datea
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FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now ill Call
^L � You must call the inspector when ready! Date Ready:
I certify that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Add�� Veet, x, or Route N.� C'tty� � Zp �� �
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Section Townshio Ranqe Fire No. County �
8 � c� � P—� e �, �-_
Address
� Contractor License Number Master License
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7/1/2000 BOARD OF ELECTRICRY COPY INSTRUCTIOMS OM 6ACK OF �ELLOW COPtl