P - 76497REQUEST FOR ELECTRICAL INSPECTION �a� �
1 � � Q Minnesota Board of Electricity �� ~
913 � J� � � g2� University Avenue Suite 5-128, Saint Paul, Minnesota 55104 ��
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(651) 642-OS00 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us �"�!�'�
Describe -using the back of the white copy if necessary - the work covered by this request: � � �
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GENERAL FEES Outdoor Lightin Standard $t
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Ampere $25 Sup lemental Fee $20
401 to 800 Am ere $50 Transformers u to 10 KVA $10
Above 800 Am ere $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin $5
0 to 200 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere $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 Insoection Trios la� $20
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 Retrafit $25 per Fixture
Center Pivot Irriaation Boom (� $40
Recreational Vehicle Park Sites $5
Se arate Bondin Ins ion $20
Special Inspection @ $30 per Hour
Special Inspection @ $.31 er Mile
THIS INSTALLATION MAY BE ORDERED
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19134964
TOTAL FEE /''�
total fee is $20) ( / i
I hereby certify that I inspeded the electrical installation descnbed herein on the dates staled:
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E%PIRE��Afl4NDONED pq�
CTED IF NOT COMPLETED WITHIN 12 MONTHS
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' Rough-in inspection Required? �Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now�Vill Call
� I�� aQ You must call the inspector when ready! Date Ready: ���� l'
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Street Address •
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Township ecti Range Fire No. Cou�ty
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, Company or Owner Perfortning Installat
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itractor or Owner rtning Installation)
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rlease Provitle Two (2) Phone Numbers IncluTling Area Code
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r License Number Master Eledncian or Power Limited Technician
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Please Provide Two (2) Phone Numbe Including Area Code
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