P - 77257REQUEST FOR ELECTRICAL INSPECTION ��
1� 812 � 1 0� � Minnesota Board L'F Electricity �- �„
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 -�
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using the back of the white copy if necessary - work cover�this request:
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GENERAL FEES Outdoor Li htin Standard $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Am ere $25 Supplemental Fee $20
401 to 800 Am ere $50 Transfortners u to 10 KVA $10
Above 800 Am re $75 Transformers over 10 KVA $ 20
CIRCUITS I FEEDERS Transformer I Power Su I for Si ns I Outline Li htin $5
0 to 200 Am re $5 �--- ONE 8 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 Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Insoection Tri�s (o? $20
ADDITIONS TO THE GENERAL FEES Reins ection Fee $20
iIFAMILY DWELLINGS PER UNIT TOTAL FEE
3 to 12 Units @$5o Per Unit (minimum total fee is $20) �c; ��
Each Additional Unit @ $25 TxisnaenFOaiNSrecroauseaa�v
OTHER ADDITIONAL FEES
Llghtin Retfofit $.25 p0f Fixfu�e I hereby certify ihat I inspected ihe electrical ins�allation described herein on �he dates stated:
Center Pivot Irri ation Boom $40 RIX1GH IN DATE
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites $5 °T0N o"'�
Se arate Bondin Ins ion $20 ��
Speciallnspection $30perHour ExaiaEOinanNOOnEO on
S cial Inspection $.31 per Mile
S INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Date: Rough-in Inspection Required? ❑ Yes �No Inspection Other Than Rough-In: �eady Now ❑ Will Call
� p( J C1� You must call the inspector when ready! Date Ready: ,�',� ��s
I ceRify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Jo� �r_ l �ddre ��1�� t/ I�IJV�.Q � CI� � � \'e �1
Name
Utility
or
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5 vci � nw enov� nneon nr ci
Please Proh�tlie T,wio (2) Phon`e �N{umbers Induding Area C
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License Nu r Master Electrician or Power Limited Te
� License Number
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Ple Provide Two (2) Phane Numbers Including Area C
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