P - 77499REQUEST FOR ELECTRICAL INSPECTION ��
2 a� 11 �� 1 O 7 � Minnesota Board of Electricity ��
� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
C� g 7�� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
De '-usi the bac th white copy if necessary - the work covered by this request: .�^��
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ENERAL FEES Outdoor Lighting Standard @$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Ampere @$25 Su lementai Fee $20
401 to 800 Am ere $50 Transformers u to 10 KVA $10
Above 800 Am re $75 Transformers over 10 KVA $ 20
C RCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin $5
0 to 200 Am ere $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins tion Tri s $20
Each S stem Device or Apparatus $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ction Fee $20
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE
3 to 12 Units @$5o Per Unit (minimum total fee is $20) J�
EachAdditionalUnitan�25 rnisnaeaFOawsaECroRUSE N�v
OTHER ADDITIONAL FEES
6t $25 pef Fixture I hereby ceRify that I inspected the electncal inslallation descnbed herein on the dates stated:
ri ation Boom $40 R°�cHiN oarE
Home Park Lots (a� $25
arate Bondin Ins ion $20 � ,__�� 2�� Z'G
ecial Inspection @$30 per Hour exPiaeoinenNOONeo pA�
ecial Inspection $.31 per Mile
INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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I certify that I am the �
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Rough-in Inspection Required? ❑Yes o Inspection Other Than Rough-In: ❑ Ready Now Will Call
You must call the inspector when ready! Date Ready:
YSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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CenterPoin`e n���vd NW
/ Company �
Suite 6
�ress (Contra or. Como a�nav�or owneMN 554'33
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Please Provide Two (2) Phone Numbers Including
(�5% l'�f� )
License Nu be¢ Master Electrician or Power Lim
� 1 �i � / _ License Number
Provide Two (2) Phone Numbers InGuding
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