P - 77582�- REQUEST FOR ELECTRICAL INSPECTION �"�'�,
1� 815 �� 0 v � Minnesota Board of Electricity �; �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
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(651) 642-OSOO TTY/MRS 1-800-627-3529 www. eleGtricity.state. mn. us
Describe -using the back of the white copy if necessary - the work covered by this request: ',' /�DS"„ Ol� �
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GENERAL FEES Outdoor Li hting Standard $1
SERVICES I POWER SUPPLIES Traffic Signal Standard $5
0 to 400 Ampere $25 Su plemental Fee $20
401 to 800 Am ere $50 Transformers u to 10 KVA $10
Above 800 Am re $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns I Outline Li htin $5
0 to 200 Am ere $5 ONE & TWO FAMILY DWELIINGS, EACH UNIT
Above 200 Am re $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 Ins ion Tri s $20
Each System Device or Ap aratus $.50 Inves ' ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee $20
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE
3 to t2 Units (� $50 Per unit (minimum total fee is $201 ����
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lighting ReUofit @ $.25 per Fixture
Center Pivot Irriqation Boom na $40
5 ial Ins ion $.31 per Mile
THIS INSTALLATION MAY BE ORDERED 1
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I hereby certiy that I inspeded ihe eledrical installation described herein on the dates slated:
ROUGHIN DNTE �
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FINAL INSPECiION
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IF NOT COMPLETED WITHIN 12
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Date: Rou h-in Ins
g pection Required? �Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ill Call
� „ �� You must call the inspector when ready! Date Ready:
I certify that I am the �`LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site SVeet Address ��y
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Township Section Ranqe Fire No. CounN
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Electrical Utility �
Contractor / Company Name
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Mailing Address (Contrador, Company or Owner Pefi
AuthoraeqSignature (Contractor or Owner Perfortni
Nlease Nrovitle Two (2) Phone Numbers Including Area
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Contrador License Number Master Electrician or Power Lin
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Please Provide Two (2) Phone Numbers Includinc
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