P - 77106REQUEST FOR ELECTRICAL INSPECTION ��
� � 910 - 0 41 � Minnesota Board of Electricity • � � . �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �.'
(651) 642-0800 TTY/MRS 1-800-6273529 www.electricity.state.mn.us ���
Describe -us' g the back of the whit copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Lighting Standard @$1
SERVICES I POWER SUPPLIES Traffic Si nal Standard @$5
0 to 400 Amoere C� $25 Sup lemental Fee a$20
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A paratus $.50
ADDITIONS TO THE GENERAL FEES
Transformers u to 10 KVA a$10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns I Outline Li htin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Reins ction Fee $20
TOTAL FEE ,..,
(minimum total fee is $20) - .
iHISAREAFORIN$PECTORUSEONLY ry �
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I herebv certiN that I inspeded the electrical installation described herein on the dales stated:
Center Pivot Irri ation Boom $40 "w""'" °"
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites $5 F�w�� �NSPec,�oN on,
Se arate Bondin Ins@ ion $20 -� � �------_— ` - /
Special Inspection �p30 � HOI�� ��REDlAfl4NWNED DAl
Special Inspection $.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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D1/� �� � � You must call the inspector when ready! Date Ready:
I certify that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elechical work at
Job SRe Street Address °
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