P - 76568' REQUEST FOR ELECTRICAL INSPECTION -
� � � � � � � 9 � � �� Minnesota Board of Electricity ��-
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using the back of the white copy'rf necessary - the work covered by this request:
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GENERAL FEES Outdoor Li htin Standard $1
SERVICES I POWER SUPPLIES Traffir Sinnal Stanriarri rnl RF
0 to 400 Ampere $25
401 to 800 Am ere a$50
Above 800 Am ere a$75
CIRCUITS / FEEDERS
0 to 200 Am ere $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Ap aratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Unfts @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Li htin Retrofd @$.25 per Fixture
Center Pivot Irriaation Boom an $40
Special Inspection $30 r Hour
Special Inspection @ $.31 per Mile
THIS INSTALLATION MAY BE ORDERE[
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Su plemental Fee a $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
InGudes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional inspection Trips $20
Investigative Fee
Reinspection Fee CaD $20
TOTALFEE O
total fee is $20) �d • �
I hereby certiy ihat I inspected Ne elechiral installation described herein on the dates stated:
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IF NOT COMPLETED WITHIN 12 MONTHS
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Rough-in Inspection Required? ❑Yes �(lo Inspedion Other Than Rough-In: ❑ Ready Now.�Vill Call
���, � d�N You must call the inspector when ready! Date Ready
I certify that I am the,.C�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecVicai work at:
Job Site SVeet Address ��Y
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Townshi Section Range Fire No. Counly
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Owner/Occupant Name Please Provide Two (2) Phone Numbers Including Area Code
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fIONS ON BACK OF YELLOW COPY
ConVactor License Number Master Electridan or Power Limited Technician
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) Please Provide wo (2) Phone Numbers Including Area Code
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