P - 76556REQUEST FOR ELECTRICAL INSPECTION �
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� � ❑ Minnesota Board of Electricity ;
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 wk-w.electricitv.state.mn.us
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GENERALFEES
SERVICES I POWER SUPPLIES
0 ro 400 Ampere $25
401 to 800 Am ere $50
Above 800 Am ere $75
CIRCUITS I FEEDERS
/ 0 to 200 Am re $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS (PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Li htin Retrofit @$.25 per Fixture
Center Pivot Irriqation Boom an $40
.�����r�is�' �i SW T Tf:H
Outdoor Lighting Standard @ $1
Traffic Signal Standard @ $5
Supplemental Fee @ $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns I Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins ection Tri s $20
Investigative Fee
Reinspection Fee $20
TOTALFEE ����Y;
(minimum total fee is $201
ihat I inspected the electrical instailation described herein on ihe dates stated:
Se arate Bondin 1ns ection $20 �,�.-�"����"" '1 � -/6 -'� �
Special Inspection @$30 per Hour exviReo nsnNCONeo onre
S cial Inspection @$.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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ua[e: �i Rough-in Inspection Required? ❑ Yes �] No �i, Inspection Other Than Rough-In: [�Ready Now ❑ Will Call
�' �`��{ �J�' �; You must call the inspector when ready! i Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER antl hereby request inspection of the electrical work at:
Job Ske Street Address �--
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Township '�. Section ��.. Range '�, Fire No. 'I County
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Owner/Occu nt Name wo (2) Phone Numbers Including Area Code
C�FIAN �#ir;-IA�L �. / _ I ( ) ( )
'� Electrical Utility � '�, Electrical Utility Address
�:CE�. EN� RGY ;
c1-iUE�IT c�l_EC..i�;it �,OhF��Ft�'1�� ContractorLicenseNumber MasterElectricianorPowerLimitedl
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I Maiting Address (Contractor, Company or Owner Performing Installation)
' ?a'�C� TEF:F:7TC?�'?�� F:GAL�a �r�IhiT �'Al1L„ i�N £5a14
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� Authorized Signature (Contractor or Owner Performing Installation) -� Please Provide Two (2) Phone Numbers Including Area
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IHSTRUCTIONS ON BACK OF VELLOW COPY � BOARD OF ELEC7RICITY COPY EB-00001A-15
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