P - 77061_ �
- REQUEST FOR ELECTRICAL INSPECTION
�- 910 � O �F � � , Minnesota Board of 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 co 'rf necessary - the work wvered by this request:
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GENER4L FEES Outdoor Li htin Standard @$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Ampere (�a $25 Supplemental Fee (a� $20
UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns I OuUine Li htin $5
ONE & 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 ction Tri s $20
Investi ative Fee
Reins ection Fee $20
TOTALFEE
(minimum total fee is $20 i
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I herebv certify that I inspected Ne electrical installalion described herein on the dates stated:
Center Pivot Irri ation Boom $40 "°°�"'" °""
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites $5 F�"uu �"sv�cr�a� onTe
Se arate Bondin Ins ion $20 ��_—�.- -�
Special Inspection $30 per Hour EX%REOIPA4NWNED nTe
Special Inspection $.31 per Mile
THIS INSTAILATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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uate: Rough-in Inspection Required? ❑ Yes �lo Inspection Other Than Rouc
D�� Q�0 J You must call the inspector when ready! Date Ready:
I ceRify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request
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