P - 77504REQUEST FOR ELECTRICAL INSPECTION
1�� p Z�('� �� � Minnesota Board of Electricity
o � 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 x•irx•.electricrh�.state.rnn.t�s
Describe -using the back of the white copy if ne��e,sg,afy-,the ytinr�CLr.que�reFJ.bythi�s �e�qu�t; _, .. ..,. �;_., ;
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-• GENERAL FEES Outdoor Li htin Standard @$1
SERVICES 1 POWER SUPPLIES Tra�c Signal Standard @$5
0 l0 400 AmDefe (� $25 Sunnlemantal Fee (nl R90
CIRGLIITS I FEEDERS
0 to 200 Am ere @$5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
C�RCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
� htin Retrofit $.25 per Fixture
Center Pivot Irr atron Boom $40
Manufactured Home Park Lots $25
Recreafional Vehicle Park Sites $5
Se arate 8ondin Ins ection $20
Special Inspection (�a $30 oer Hour
Transformers u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer I Power Supply for Signs / Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trios an $20
TOTAL FEE ^c� �
total fee is $201
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tha� I inspected the elechical installation descnbed herein on the dates s[ated:
S INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12
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�vaie: - I Rou h-in Ins ection Re uired? ❑Yes ' y ❑Will Call
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�__ _�__ __ �ou must call the inspector when ready! _I Date Ready:
I ceRify that f am the L�] LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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Please Provide Two (2) Phone Numbers
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i CMtradOr / Company Name Contractor License Number � Master Electrician or Power Limited
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Mailing AddresS (Contractor, Company or Owner Performing Installation)
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I Authora¢d S" nature (Contractor or Owner Performing Installation) �I Please Provide Two (2) Phone Numbers Including Are
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IN$TRVCTIONS ON BACK OF YELLOW COPY BOARD OF ELECTRICITY COPY pa_nnmm�_�