P - 76499REQUEST FOR ELECTRICAL INSPECTION �
� � � 8�� s 7�� �� ��, Minnesota Board of Electricity t
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
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(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request: �
1�F. E�(/ -- /LUf l� �/ (� Y'J✓� �� -'Y] ,S.
GENERAL FEES Outdoo Li hting Standard $1
SERVICES I POWER SUPPLIES i i Traffic Cinnai Rtandard n A5
' Above 200 Am ere a$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Li hting RetrofA @$.25 per Fixture
Center Pivot Irriaation Boom GD �40
I THIS
�d Home Park Lots a $25
I Vehicle Park Sites a$5
mdin Ins ec6on $20
ection @ $30 r Hour
ection @ $.31 r Mile
LLATION MAY BE ORDERED
lill II III il lil I�'ii II III II ill II III II III �� I�
18237867
Supplemental Fee $20
Transfortners u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su t for Si ns I Outline Li htin $5
ONE 8 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 Ins ction Tri s $20
Investi ative Fee
Reins ion Fee $20
TOTAL FEE /
(minimum total fee is $20) � (� �
I hereby certify that I inspeded the elecVical installation desaibed herein on the dates stated:
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IF NOT COMPLETED WITHIN 12 MONTHS
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"Q. Rough-in Inspection Required? ❑ Yes C71 No Inspection O[her Than Rough-In: � Ready Now � Will Call �
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r� J I— O �j You must call the inspector when ready! Dffie Ready:
I cerfrfy that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site SVeet `ddress � City �
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upant Name
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iress (Contr or, Company or
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Please Provide Two (2JPhorie Numbers Including Area Codf
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License Number Master Electrician o ower Limited Techn
_ . .� . _ _. License Number
Two
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