P - 76380'7 REQUEST FOR ELECTRICAL INSPECTION ����'�'� .�
2��-��� `� � 1 2 � Minnesota Board of Electricity � I
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 >`�.
(651) 642-0800 TTY/MRS 1-800-6273529 www.electricity.state.mn.us ���
Describe -using the back of the white copy if ecessary - the work �ered by this request:
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GENERAL FEES Outdoor Lighting Standard $1
SERVICES I POWER SUPPLIES Traffic Si nal Standard @$5
0 to 400 Ampere Ca? $25 Supplemental Fee @$20
Above 200 Ampere a $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
Each Additional Unit @
Lighting Retrofit @ $.25 per
Center Pivot Irriaation Boom
to10KVA@$10
;r 10 KVA C�a $ 20
� Transformer I Power Supply for Signs / Outline Lighting @$5
ONE 8 TWO FAMILY DWELIINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwe�ling Unit @$SO
Additional Inspection Trips @ $20
Investiaative fee
TOTAL FEE � \�C
total fee is $20) '� �
the elecVical installation described herein on the dates staled:
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S ial Ins ion $.31 per Mile
THIS INSTALLATION MAY BE OR_DERED DISCONNECTED IF NOT COMPLETED WITHIN 1
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Date: Rou h-in Ins ian R uired?
g pect' eq ❑ Yes �No Inspection Other Than Raugh-In: ❑ Ready Now Will Call
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� j' '�' ���"' � 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: