P - 76691REQUEST FOR ELECTRICAL INSPECTION � �.,
1��� o°`t � Z ,� Minnesota Board of Electricity �-�
❑ �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OS00 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us ��
Describe -using th� k of the white copy if ne �ssa�he w� covereij by this request:
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- GENERAL FEES Outdoor Lighting Standard $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Ampere $25 Supplemental Fee $20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Am ere $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transfortner 1 Power Su i for Si ns / Outline Li htin $5
�J,O 0 to 200 Am re $5 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, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Insoection Trios na $20
Each S stem Device or A paratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units C�D $50 Per Unit
Center Pivot Irrigation Boom @
Manufactured Home Park Lots
Recreational Vehicle Park Site:
THIS INSTALLATION MAY BE ORDERED
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TOTALFEE
(minimum total fee is $20) � +S�
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I hereby certily that I inspeded the elecUical installa6on -escribed herein on the dates stated:
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Date: Rou h-in Ins ection R uired?
g p eq ❑ Yes ❑ No InspecGon Other Than Rough-In: � Ready Now ❑ Will Call
�`' � � 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 aL
Job Site Street Address r L�Q,� City
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Section Range Fire No. County �
Piease Provide Two (2) Phone Numbers Including Area Ca
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Electrical Utility Address
Address (Contractor, Company or
ized Siariature (Contractor or Ow�
Master Electrician or Power Limited Technician I
License Number
Please Provide Two (2) Phone Numbers InGuding Area Code
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