P - 78602�(� REQUEST FOR ELECTRICAL INSPECTION
1�,7 J�- 9 0 9� Minnesota Board of Electricity -
' • �+��� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� l (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW MODEL ❑ ADDITION ❑ REPAIR Describe -/using the back of t/he� white copy'rf necessary - the work covered by this request:
(€��'� � /�'_/f0 �
�
ENERAL F ES Outdoor Li htin Standard $1
SERVICES I POWER SUPPLIES Traffic Si nal Standard SS
0 to 400 Amcere � 825 Sunnlamanial Fap �nl R711
ALARM, COMMUNICATION, REMOTE CANTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device w Apparatus @ E.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLIN�S PER UNI
3 to 12 Unils �$50 Per Unft
Each Additional Unit � E25
OTHER ADDITI�IAL FEES
Li� htin Retrofit $.25 er Fixture
Center Pivot Irriga6on Boom � $40
Manufactured Home Park Lols S25
Recreational Vehicle Park Sifes SS
Se arate Bondin Ins $ZO
Spea� Inspection � $30 per Hour
I II� II III I� (II II III I� �I II �II� II I�I ���� I�
13999099
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes th�.Service andlor Power Supply up to 500 Amperes, All
CirouiLS and Two Inspection Trips Each Dwelling Unit � S80
TOTAL FEE �
(minimum total fee is $20) �
Tws ueE,� wn r�cTOn usE aar
I hereby cerdfy that I i�pected Ihe elflcbical i�tl�on desaibed here� on Ihe daBes afabd:
•
F6R 6rFt�E USc tiHLY
���� � � �
0.�•�
�R.yuea� vu�e: ,.��"� Raugnin Inspecfion Required? LJ Yes 2l�.No Inspeciion Other Th� RougMn: �Ready Na+�ill Call
��1�;3�./� I Ya must call the inspector when readyl Date Ready:
I certify that I am 1he�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby 2quest nspection d the elactrical work at: