P - 77204REQUEST FOR ELECTRICAL INSPECTION `������,..
1 814 251 3 � ` �
� � ❑ Minnesota Board of Electricity K; �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �. `
�� � 8 (651) 642-0800 TTYIMRS 1-800-627-3529 www.electricity.stale.mn.us ���
Describe -using the back of the wh' e copy if necessary - the work covered by this request:
� IoSI- �1��1- �1$S"�
GENER4L FEES Outdoor Lighting Standard $t
SERVICES / POWER SUPPLIES Traffic Sianal Standard la� $5
u co �uu nm ere m�o u r C P�
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unit
Each AddiGonal Unit @ $25
OTHER ADDITIONAL FEES
Li htin Retrofrt $25 per Fixture
Center Pivot Irri ation Boom $40
Manufactured Home Park Lots $25
Recreational VehiGe Park Sites $5
Se arate Bondin Ins ion $20
S cial Inspection $30 r Hour
S ial Ins ion $.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCOI
I ��ll II III �I i�l �� ��� �� ��� �� ��! �� ��� �� ��� M� I�
1 8], 4� 51 3
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns I Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Inctudes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins tion Tri s $20
Investi ative Fee
Reins ion Fee $20
TOTAL FEE
(minimum total fee is $20) p2�
THIS AREA FOR INSPECTOR USE ONLY
I hereby certifY that I inspeCed ffie electripl installation described herein on ihe dates stated:
° NOT COMPLETED WITHIN 12 MONTHS
��-�v�7�
Date: Rou h-in Ins ection R uired? ❑Yes Ins
g p eq pection Other Than Rough-In: ❑ Ready Now ill Call
3- a �-�� You must call the inspector when ready! Date Ready
I certify that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecVical work at