P - 77294REQUEST FOR ELECTRICAL INSPECTION �"�
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I 1� O��� 121 � Minnesota Board of Electricity k:
1821 University Avenue S ite S-128, Saint Paul, Minnesota 55104 �'
(651)642-0800 -800-627-3529 www.electricily.state.mn.us
Describ -u i g the b ck of e white copy 'rf necess ry- t�e wor r ue t:
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NER4L FEES door Liahtina Standard Cd $1
✓ICES I POWER
0 to 400 Amcere
tM, COMMUNICATION, REMOTE CONTROL,
:UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL F
TIFAMILY DWELLINGS (PER UNIT)
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
Lighting Retrofd @ $.25 per Fi�ure
Center Pivot Irrigation Boom @ $40
Manufactured Home Park Lots l�D $
Su plemental Fee @ $20
Transformers u to 10 KVA a$10
Transformers over 10 KVA a$ 20
Transformer I Power Su I for Si ns / Outline Li htin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins ection Tri s a$20
Investigative Fee
Reinspection Fee $20
TOTAL FEE /� ' �
(minimum total fee is $20) rf
I inspected the electrical installation desaibed herein on the dates stated: �
S ial Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Date: Rou h-in Ins ection R uired?
g p eq ❑ Yes Inspection Oth r Tha -I y Now ❑ Will Call
You must call the inspector when ready! Date Ready:
I cerMy that I am th LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby requ t�nspection of the electrical work at
Name
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License Number
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