P - 77433p/� REQUEST FOR ELECTRI L INSPECTION �
� �� O�F �� 6� 1� Minnesota Board of Electricity p��,s-� ar3� � ,��
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us ��"
D ribe -using the baCk of the hite cop if necessary - the work covered by his requ t: �
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SERVICES / POWER SUPPLIES
0 to 400 Ampere @ $
401 to 800 Am ere $50
Above 800 Am ere $75
CIRCUITS I FEEDERS
0 to 200 Am ere $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or A paratus $.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
li hting Retrofd @$.25 per Fi�Rure
Center Pivot Irri aGon Boom $40
ManuNactured Home Park Lots $25
Recreafional Vehicle Park Sites (� $5
THIS INSTALLATION MAY BE ORDERED C
I 11lI II III II III II III II II! II NI II lil II III �� I�
184768L2
.
Outdoor Li ting Standard $1
Traffic Si nal Standard @ $5
Su lemental 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
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
� Investiqative Fee
TOTAL FE j I t� �,
total fee is $20 �
I inspected the electrical installation desaibed herein on the dates stated: �
IF NOT COMPLETED WITHIN 12
L°`�� ,.�/ ,^ ��� Rough-in InspecGon Required? ❑ Yes ❑ No Inspectian Other Than Rough-In: ❑ Ready
/ /i
(r f/ You must call the inspector when ready! Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of tf
Job Site SVeet Addre ��,
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Please Provide Two 2) hone Numbers Including Area
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Please Provide Two (2) Ph e Numbers Including Area
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