P - 76392�� REQUEST FOR ELECTRICAL INSPECTION ��.� ��
2� o(� �,� � 7 2 a Minnesota Board of Electricity �- � I
v 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104 �.
� � �`, (651) 642-0800 TTYIMRS 1-800-627-3529 wxtiv.electricity.state.mn.us �,��
De '-usin the back white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Li htin Standard $1
SFRVICFS / PnWFR SIIPPI IFS Traffic Signal Standard @$5 _
0 to 400 Ampere $25
401 to 800 Am ere a$50
Above 800 Am ere $75
CIRCUITS I FEEDERS
0 to 200 Am re $5
Above 200 Am re $1
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or A aratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Liahtina Retrofit f�a 5.25 cer Fixture
Manufactured Home
Supplemental Fee a $20
Transformers u to 10 KVA a$10
Transformers over 10 KVA a$ 20
Transformer I Power Su I for Si ns I Outline Li htin $5
ONE & 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
Additional Inspection Trips @ $20
Investiqative Fee
TOTAL FEE �
total fee is $201 �Q
I insoected the electrical installalion described herein on the dates stated:
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Speciallnspection $30 rHour `"""`","°","".`" I
Scecial Inspection (� $ 31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTEDyIF NOT COMPLETED WITHIN 12 MONTHS ______A
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Dat� ���� Rough-in Inspection Required? ❑ Yes �No Inspection Other Than Rough-In: ❑ Ready Now �Will 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: