P - 77551p REQUEST FOR ELECTRICAL INSPECTION
1� O��� 4 2 6� Minnesota Board of Electricity � :
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �:
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
Describe -using the back of the white copy 'rf necessary - the work covered by this request: ��
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GENERAL FEES Outdoor Li htin Standard $1
SERVICES / POWER SUPPLIES .. Traffic Cinnal Rtandarr� n P�,
ALAKM, I;UMMUNIGATION, REMOTE CANTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus $.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 r Fixture
Center Pivot I' tion Boom $40
Manufactured Home Pa Lots $25
Recreational Vehicle Park Sites (� $5
ction @ $.31 per Mile �
.LATION MAY BE ORDERED C
I I�I � I� II lil li iii � �II II. III II III II III �� I�
18224261
Supplemental Fee @ $20
Transformers u to 10 KVA a$10
Transformers over 10 KVA a$ 20
Transformer / Power Su I for Si ns I Outline Li htin $5
ONE 8 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
Add'Rional Inspection Trips @ $20
Investigative Fee
TOTAL FEE I
(minimum total fee is $20) �.�� -J�,
_ .y^� THISAREAFOftINSPECTORU5E0NLY r/��
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I hereby certify that I inspected ihe electrical installatioA des�'cn'bed �e�s�ted:
ROUGH IN ��
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FIN4LINSPECTION . ��
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CONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Date: Rough-in Inspectian Required? Yes ❑ No In
spec[ion Other Than Rough-In: 0 Ready Now ill Call
�- I�-- �� You must call the inspector when ready! Date Ready
I certity that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Sde Street Address ��,
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Utility
: "�I�'�ic Senrices
an ner I paU�
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Piease Provide Two (2) Phone Numbers Induding Area Code
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ise Number Master Electrician or Power Limited Techni
�License Number
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PI vide Two 1�Phon mbers Includin ea Code
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