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O Minnesota Board of Electricity �'} y� �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
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(651) 642-0800 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:
� Above 200 Ampere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT _
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Traffic Si nal Standard $5
Su lemental Fee $20
Transfortners u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns I Outline Li htin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppiy up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins tion Tri s $20
Investi ative Fee
Reins ction Fee $20
,,..� �n TOTAL FEE
�'�'�^' �(r'r�imum total fee is $20) 3 0• j�
Lighhng Retrofit @$.25 per Fixture I hereby certify thal I inspected fhe electrical installalion described herein on ihe dales stated:
Center Pivot Irri ation Boom $40 RWGHIN pATE
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites $5 FINAL INSPECTION ----°--ti DATE
Se arate Bondin Ins eclion $20 �-----1 �^ Z� Y--� �
Special Inspection $30 per Hour EXPIREOIFBFNOONEO �„�
Special Inspection @ $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS _ _
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I I�il II III II I�I II �li li ��I I III II III II III II I� I II�
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1tl1e: I Rough-in inspection Required? ❑ Yes �o Inspection Other Than Rough-In:��jteady Now OWill Call
���3 ��� You must call the inspector when ready! Date Ready: /`•'
I certify that I am the ICENSED CONTRACTOR � COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Street Addre s City
�� �Li ULor..�'r--6�fcr9C}o S'� • _T .
Contractor
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� Kange Fire No. County (T
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n, Please Provide Two (2) Phone Numbers InGuding Are
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oal UtilityAddress
Contractor License Number Master Electrician or Power Limited
-�}- � _� , e , i) License Number
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OF ELEC CITY COPY EB-00001A-15 8.1. 2004