P - 77659REQUEST FOR ELECTRICP�L IN PECTI N ��g�'���
I ��� � O� � Minnesota Board of Electricity ot���Qo��� �- s�
� � 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 5510
(651) 642-0800 TTYIMRS t-800-627-3529 wmH�.electricity.state.mn.us
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Describe -using the back of the white copy if necessary - the work covered by this request: 1'� ^� f
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GENERAL FEES Outdoor Lighting Standard $1
SERVICES / POWER SUPPLIES Traff Signal Standard $5
0 to 400 Ampere $25 ' Supplemental Fee @$20
401 to 800 Am ere $ Transformers u to 10 KVA $10
Above 800 Am ere 75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin $5
0 to 200 Am ere $ ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, OTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF L S THAN 50 VOLTS Additional Ins ection Tri s $20
Each S stem Device o Apparatus $.50 Investiqative Fee
ADDITIO S TO THE GENERA
MULTIFAMILY DWELLING PER UNIT
3 to 12 Units (�a $50 Pe
Unit @ $25
OTHER ADDITIONAL FEES
na $.25 per Fi#ure
Center Pivot
Speciai Inspection @ $30 per Hour
Special Inspection @ $.31 per Mile
THIS INSTALLATION MAY BE ORDERED
I IIII II I� �) III I) III II (I� I� II) II III II III �� I�
1887607�'.
TOTALFEE
total fee is $20)
0
I hereby certify that I inspected the electrical insfallation described herein on the dates stated:
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NOT COMPLETED WITHIN 72 MONTHS
���/��� Rough-in Inspection Required?� Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call�
7 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:
Job Site Street Address ��, -�
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Township Section Range Fire No. Cou
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Owner/ ccupant Name Please Provide Two (2) Phone Numbers Including Area Code
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ElECtrical
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Electrical Utility Address
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ON BACK OF YELLOW COPY BOARD OF ELECTRICITY COPY
�er Ma� Electri�n or Power Limited Technician
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rovide Two (2) Phone Numbers Including Area Code
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