P - 77486REQUEST FOR ELECTRICAL INSPECTION ��"�
2�� 0�� 5 3 2� Minnesota Board of Electricity � Gj
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1821 University Avenue Suite S-128, Saint Paul, Minne� ��5�104 s�
(651) 642-0800 TTY/MRS 1-800-627-3529 wwev.electricity .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 hting Standard $1
SERVICES I POWER SUPPLIES Traffic Si nal Standard $5 '
0 to 400 Ampere @$25 Su lementai Fee $20
401 to 800 Am re $50 Transformers u to 10 KVA $10 �
Above 800 Am re $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin $5
0 to 200 Am ere $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere $10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ction Tri s $20
Each System Device or Ap aratus $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins tion Fee $20
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE �//�
3 to 12 Units @$5o Per Unit (minimum total fee is $20) rJ�(Ji �
Each Additional Unit @$25 rxis aaEn Fat insPEaoa usE or�iv
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OTHER ADDITIONAL FEES �
Li htin Retrofit @$.25 per Fixture I hereby certif�t�at I inspected th lectrical installation described herein on the dates stated:
Center Pivot Irri ation Boom $40 RWC� �^' oa.e
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites $5 F �NSPE�T�oN � o�TE
Se arate Bondin Ins ion $20 Z�/Z._.� 7
Special Inspection @$30 per Hour E%PIRED/A&qN00NED pq�
Special Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Date: Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now ill Call
�/��/ v� You must call the inspector when ready! Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site SUeet Address ��,
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Township Section Range Fire No. County
Owner/Occupant Name Please Provide Two (2) Phone Numbers Including Area Code
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Electrical Utility Electrical Utility Address
CRntractor / Company Name . Contractor License Number Master Electrician or Power Limited Technician
` , , ��, • , _� '�, ; �_ � „ � ��� License Number
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Mailing Address (Contractor, Company or Owner Performing Installation)
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A_ythorized Signature (Contrador or Owner Perfortning Installation) lease Provide Two (2) Phone Numbers Including Area Code
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INSTRUCTIO S ON BACK OF YELL W PY BOARD OF ELECTRICITV COPY EB-00001A-75 8.1. 2004