P - 77639REQUEST FOR ELECTRICAL INSPECTION �
1 s��51 � 0 4 6�: Minnesota Board of Electricity �Q�� „�`j��(`' ��
� 1821 University Avenue Suite 5-128�int aul, �l�nnesots �5104 �`,
(651) 642-0800 TTY/MRS 1-800-6273529 www.electricity.state.mn.us � " "
Describe - ing the back of the e copy'rf necessary - the work covered by this re est: ,
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GENERAL FEES Outdoor Lighting Standard $1
SERVICES I POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Ampere $25 Su lemental Fee $20
401 to 800 Am ere $50 Transformers u to 10 KVA $10
Above 800 Am ere $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer I 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 re $10 Includes the Service and/or 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 ection Tri s $20
Each S stem Device or Apparatus @$.50 Investi ative Fee
ADDITIONS TO THE GENER4L FEES Reins ection Fee $20
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE
3 to 12 units @$50 Per Unit (minimum total fee is $20)
Each Additional Unit @ $25 THISAREAFORINSPECTORUS
OTHER ADDITIONAL FEES
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LI hting ROtfOfit $25 per Fixture I hereby certify that I inspeded the electrical installation desaibed herein on the dates stated: �
Center Pivot Irrigation Boom $40 R�'�""
Manufactured Home Park Lots $25
Recreational Vehicle Park Sdes $5 F'"^�"a°ECT'°" ,
Se rate Bondin Ins on $20 ��'�
Speciallnspection $30perHour E%PIREDIRflW00NED
Special Ins 'on $.37 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITt
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uac / Rough-in Inspection Required? ❑Yes �NO Inspection Other Than Rough-In�Ready Now ❑ Will Call
�//'O�+ You must calf the inspector when readyl Date Ready:
I certi(y that I am th�LICENSED CONTRACTOR ❑ COMPANY O OWNER and hereby request inspection of the electrical work at:
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Please Provide Two (2) Phone Numbers Includi
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Name / . ConVador License Number Master Electriaan or Power Limited Technician
�+ ' Z �V � 739 License Number / � �
Fador, C p y o e rfortning InstallaGon)
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�( on r orming Installation) Please Pro e Two (2) Phone Numbers Including Area Code
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