P - 75962REQUEST FOR ELECTRICAL INSPECTION �°'..,
1� Q� 0��F 2� � Minnesota Board of Electricity
v 1821 University Arrenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.vs
Describe -using the back o�fFe white copy'rf necessary - the work covered this request:
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GENERAL FEE Outdoor Liq ng Stan ard @$1
A�ve 800 Ampere @ $75 - I
:UITS / FEEDERS
0 to 200 Am�re @ $5
Above 200 Ampere @$70
iM, COMMUNICATION, REMOTE CONTROL, SIGNALING
;UITS, CIRCUITS OF LESS THAN SU VOLTS
Each System bevice or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
TIFAMILY DWELLINGS PER UNIT
3 to 72 UniGs @$50 Per Unit
Each Addi�onal Unit @ $25
OTHER ADDRIONAL FEES
Lightlnc Retroflt @ $.25 per Fbdure
Ce�der P'nrot IMgation Boom @ $40
Manufactured Home Park Lots �$25
Recreational Vehicle Park Sit�s CrD $5
►LLATION MAY BE ORDERED [
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18204230
� Transformer / Poarer Suppty for Signs / Outfine LigMim� @$5
ONE & 11N0 FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuiis and Two Inspection Trips Each Dwelling Unit (a� $80
Addi�onal Ins edion Tri s a$ZO
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InvesUgative F�
Rems ection Fe,e (� $20
TOTALFEE J �
(minimum total fee is $20) Ip
T199 AI�A FOR P13PECf OR IISE OM.Y
I hereby certlry U�at I i�rspeded the elecUical inafallatlon de�ibed irerein on the
NOT COMPLETED NFlTE
WQR OF Fi�.,E UuE ONLY
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�� Rough-in Inspectlon Required7 ❑Yes �No Inspedion OtherThan Rough-In: � Ready Now �Will Call
��a�-� 6 You must cali the inspector when readyl Date Ready. �"�� ��� �
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection af the electrical work at
Job Sfte Sheet Address ��Y
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pwner/pccupe�► Name Please Provtde Two (2) Phorte Numbers Indudhtg Area Cade
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Addresa (Contrador. Gomoanv or
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Llcense Number
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