P - 75864/� REQUEST FOR ELECTRICAL INSPECTION �'� �
1��� o�`# 0 3� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
r (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us �"' "�
Describe �"e b,ack of the whde copy'rf nec�ssaty -4he arork covere�i by this requ�t:
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GENERAL FEES Outdoor Liahfma Standard (a� $1
400
over
Above 200 Am re $10 Includes the Service andlor Power Supply up to 500 Amperes, A�
tM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Txro Ir�spection Trips Each Dwelling Unit @$80
�11TS, CIRCUITS OF LESS THAN 50 VOLTS Addfional Ins 'on Tri $2Q
Each S em Device or Apparatus @$.50 Invesfi ative Fee
ADDITIONS TO THE GENERAL FEES Reins 'on F� $20
fIFAMILY DWEWNGS PER UN TOTAL FEE ��f'�
3 to 12 Units @$50 Per Unit (minimum total fee is $20) �� ��
Each Additlonal Unit @ $25 "°s"`�"`°'°°�`'�°R's�°ruY
OTHER ADDRIONAL FEES
Retrafit $25 r Fodure i nereby cenKy tnat i i� me �e� h�tancn d�amed ner�n on ate aama �red:
Center Pivat Irtination Boom (a? $40 �1°'�' °ATE
•27�E1
6on �$.31 per Mile I I
ATION MAY BE ORDERED DISCOIVNECTED.IF NOT COMPLETED WITHIN 12 MONTHS
FOP. Crf FiC�� �JSE t1NLY
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�� � Rough-in Inspectlon Required? ❑ Yes ❑ No Inspecdon Other Than Rough-In: ❑ Ready Now � WIU CaU
w� I��� You must ca0 the inspector when readyi Date Ready:
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby r�uest inspection of the electrical work at
Job Site Sfi�et Addrass C'
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Township Sectlon Range Flre No. CouMy _
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I Utility Address
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� ;, py Conbador Lic�se Ninnber Master ElecMcfan or Power Ltmited Technician
� y�0"" License Number
Idress (Contractor, Comparry or er Pertormirtg Insta0a6on)
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_ r Pertormfng Instellatlon) RI se Provlde Twa (2) Phone Numbers Ir
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