P - 77325Q REQUEST FOR ELECTRICAL INSPECTION �
1� 8 6 3� 2 O 4 �` Minnesota Board of Electricity � n�
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 -
(651)642-0800TTYlMRS1-800-627-3529 www.electricity.state.mn.us � ��
Describe -using the back of the white copy if necessary - the work covered by this request: � �
ENERAL FEES Outdoor Liohtina Standard an $1
I SERVICES I
Above 800 Am ere $75
CIRCUITS I FEEDERS
0 to 200 Am ere $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CANTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irriqation Boom an $40
Traffic Si nal Standard @ $5
� Supplemental Fee @ $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns / 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 Ins ion Tri s $20
Investi ative Fee
Reinspection Fee al� $20
total fee is $20) � � �'
I inspected the electncal installation descnbed herein on the dates stated: �
- Z� o! �
S ecial Inspection $.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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18692046 � �
Date: Rough-in Inspection Required? ❑ Yes �Jo Inspection Other Than Rough-In: �teady Now � Will Call
g—� 3— �� You must call the inspecror when ready! ( Date Ready: � v
I certify that I am
Job Site Sheet Ad�
�10 3
I Contrador
CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
, C'�-1 . .. .
or
ection v Range Fire No. County
Please Provide Two (2) Phone Numbers
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Iedncal Utility Address
Contractor License Number Master Electrician or P
`_p__ ��,� 1 i A License Number
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� Provide Two (2) Phone Numbers InGuding
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