P - 77303q REQUEST FOR ELECTRICAL INSPECTION °'�`�`���.�
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1� 8� 3��� 6 ,j� Minnesota Board of Electricity �� ��
� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 5510 �'
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state. �,��
De cribe -usin8 the baFk of the white copy if necessa� ork covered by this request:
GENERAL FEES Outdoor Liah inq Standard C�a $1
401 to 800 Am ere $50
Above 800 Ampere $75
CIRCUITS / FEEDERS
0 to 200 Am re $5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Li htin Retrofit $.25 per Fixture
Center Pivot Irriaation Boom (� $40
Transfortners u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns / 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 Ins tlon Tri s $20
Investi ative Fee
Reins ection Fee $20
TOTALPEE
(minimum total fee is $20) �
THISAREAFORINSPECi0f2USE LV
I hereby certify that I inspecled Ne electrical installation described herein on fhe dates stated:
:ction @ $30 per Hour Ex"�n�^B^"oo"Ee.i �
action @ $.31 per Mile
LLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTH£
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"O1 � �� Rough-in Inspection Required? ❑ Yes �No Inspedion Other Than Rough-In: ❑ Ready Now�Will Call
You must catl the inspector when ready! Date Ready:
I cerFrfy that I am the LICENSED CONTRACTOR � COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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INS ON BACK OF YELLOW COPY
Fire No. Cc
Please Provide Two�J
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Area
contraaor Li nse Number Master Electrician or Power Limi[ed Technician
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�Ilation) Please Provide Two (2) P/h'one Numbers InGuding Area Code
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BOARD OF ELECTRICITV COPY FR110l10�A_14 a� onne