P - 77637REQUEST FOR ELECTRICAL INSPECTION '�
I 1� 8.5 � a"� o�I, 9 � Minnesota Board of Electricit �Q�� h �(',�� �- N��
� � 1821 University Avenue Suite S-128, Saint PauT MiFrfi��ot�`104 k �,
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us �" `
Describe - si g the back of the ite copy if` ecessary - the work cov red by this request:
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GEN L FEES Outdoor Li htin Standard $1
SERVICES I POWER SUPPLIES Traffic Signal Standard $5
0 to 400 Ampere $25 Supplemental Fee $20
401 to 800 Am re $50 Transformers � to 10 KVA $10
Above 800 Ampere @$75 Transformers over 10 KVA na $ 20
;M, COMMUNICATION, REMOTE CONTROL,
UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus a(� $.50
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irriaation Boom (�D $40
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
Investigative Fee
Reinspection Fee an $20
total fee is
I hereby certity that I inspected the electrical installation described herein on the dates stated: �
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SpeCial InSp2Cti0n $30 p2f HOUr exaiaeoinaanooneo onre I
Special Inspection @ $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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185L0495
I certi� that I am the
i
ny Name
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Rough-in Inspection Required? ❑Yes�No Inspedion Other Than Rough-In�Ready Now � Will Call
You must call the inspector when ready! Date Ready:
VSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
cay
�NaoR� D�e� r�� �,o,�� �
Section Range Fire No. County
�iv0 �
(7�.��0� - 7��� ) -
ense Number Master Electrician or Power Limited Tec
�4�,,, /t License Number �� /� �
CJ
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Please Prov e Two (2 P one Numbers ncluding Area Cc
(7GB - �od )
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