P - 75859REQUEST FOR ELECTRICAL INSPECTION '
1� 9 9 0°��� � Minnesota Board of Electricity I
1829 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�1 � �...1� C-a, (851)642-0800T1Y/MRS1-800-627-3529www.eleciricity.state.mn.us
D�cribe -using the back of white copy if nec�ssary - the urork covered by this r�uest:
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SERVICES / POWER SUPPLIES
0 to 400 Ampere @ $25
401 to 800 Am re$50
Above 800 Am re $75
IRCUITS / FEEDERS
0 to 200 Am re$5 �
A6ove 200 Am re $10
HIARM, COMMUNICATION, REMOTE CONTROL, SIGNALI
CIRCURS, CIRCUITS OF LESS THAN 50 VOLTS
Each em Device or A s@$.50
ADDffIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UN
3 ta 12 Units @$50 Per Unit
Each Addidonal Unit @ $25
OTHER ADDII'IONAL FEES
Lighting Retrofit � $25 r FbRure
CeMer Pivot Irti aGon Boom @$40
Manufactured Home Park Lois $25
Recreabonal Vehicle Park Sita $5
Se e Bomli I� 'on $ZO
Sp�al Ir�spection @ $30 �r Hour
S Ir�s on $.31 r Mile
THIS INSTALLATION MAY BE ORDERED
iffll IIIII II�I �I� III� Illfl II�I QI� 0� I� �
19905579
Su lemental Fe.e @ $20
Transfomrers u to 10 KVA (al, $10
Transformers over 10 KVA �$ 20
Transformer / Power Su i tor Si ns / Outl'me Li " $5
ONE & PNO FAMILY DWELLINGS, EACH UNIT
Includ� the Service and/or Power Supply up to 500 Amperes, All
Circaiits and Two InspecUon Trips Each Dwalling Unit @$60
TOTALFEE
total fee is $20)
I hereby �rtHy that I 6�eded the electrtcel I�atlon d�albed trereln on ihe dat� afet�: �
NOT COMPLETED lNITHIN 12 MONTHS
FQR OFFtCE USE ONLY
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��� Rough-in Inspectlon Requlred7 ❑Y� �lo Inspedton Other Then Rough-In: 0 Ready Now�Wftl Call
��� ��`p You must call Ure inspactor when readyl Date Ready:
I certify that I am the LICEPISED COMRACTOR ❑ COMPANY ❑ OW1�1ER arM hereby request insp�tion of the electric�l work at
Job 3lte Street Ad CItY
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Township Secdon Renge Flre No. Co
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O�ner/�pant Nart� Please Provide Two (2) Phorre Numbers Im�udNg Area Code
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Centerpoint Ener y
An�MN 55304
License Number
� InslaDat i) Please Provide Two (2) Phorre Nt
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