P - 77254REQUEST FOR ELECTRICAL INSPECTION �����'�
1� O 1�- 711 � Minnesota Board of Electricity �- ;:�
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104 _�
(651) 642-0800 TTYIMRS 1-800-t327-3529 www.electricity.state.mn.us ���
Describe -using the back of the white Gopy if necessary - the wp�k co�redpy.this request:
� SERVICES I POWER SUPPLIES
0 to 400 Ampere (o? $25
ALARM, COMMUNICATION, REMOTE CANTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or A aratus $.50
ADDITIONS TO THE GENERAL FEES
Each Additional Unit @ $25
OTHER ADDITIO
L'ghtirg Retrofit @ $25 per Fixture
Center Pivot Irriqation Boom (� $4(
�ection @ $.31 per Mile �
,LLATION MAY BE ORDERED I
IIII �I I�� I�I�I IIIII IIIII (IIII IIIII IIIII �� (�
1�81,271L8
Supplemental Fee $20
Transformers u to 10 KVA a$10
Transformers over 10 KVA a$ 20
Transformer I Power Su I for Si ns I Outline Li htin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
Investigative Fee
Reinsaection Fee na $20
TOTALFEE
total fee is $201 � i•� 5��
I insoected the elecUical installa6on desaibed herein on ihe dates stated: I
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IF NOT COMPLETED WITHIN 12 MONTHS __ _
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Date: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: Ready Now ❑Will Call
� 1��/� 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 ai
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/ Company Name , Contractor License Number Master Electrician or Power Limited Technician
License Number
iress ( onyapor, ompany or Owner Pgrfortning Installation-) \
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