P - 78655REQUEST FOR ELECTRICAL INSPECTION
1�� 4 7- 313 ��`� mm Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
, � A�� �. (651) 642-0800 TTY/MRS 1-800-627-3529 =
www. electricity. state. mn. us
�....._.
Identity the work covered by this request:
❑NEW �iEMODEL ❑ADDITION ❑REPAIR � �� ��
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re�$25 Su lemental Fee (� $20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / OuUine L' htin �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dxrelling Unit �$BO
-�--' "--', CIRCUITS OF LESS THAN 50 VOLTS
System Device or Apparatus � $.50
ADDITIONS TO THE GENERAL F
�ILY DWELLINGS (PER UNin
2 Units � $50 Per Unit
Additional Unit � $25
OTHER ADDITIONAI FEES
Pivot Irrigation Ba
�tured Home Park
ional Vehicle Park
Fee �
(minimum total fee is $20) � y/
F011 INSPECTqi USE ONLY
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I her�by cerh'ty that I inspected ihe electripl instsllation desaibed hereir(on y�e de(es gtap
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5 ial Ins ection �$.31 er Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED PLETED
FOR OFFICE USE ONLY
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L �/o`°�/ (J�� � You must call the inspector when ready�
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY
Job Address (Street, Box, or Route Nv,� ��
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Date Ready: I
NER and hereby request inspection of the electrical work at:
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Contractor License Number Master Lkense
� Address (CoMraaor, Company or Owner
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zed Signature (Cqntractor, Comoanv or O�
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