P - 77435REQUEST FOR ELECTRIC INSPEC�TIQ / ��
I 1s 8��� c� � 9 8 � Minnesota Board of Electricity ��� '" (...r��io�c^ `��
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �' �.
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us �"� :
Describe -usin th� of the white co 'rf necessary - the work�overed by is request: Yr��v \l�` �
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GENERAL FEES Outdoor Lightinp Standard na. $1
/ POWER
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus $.50
ADDITIONS TO THE GENERAL I
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofrt @ $.25 per Fixture
Center Pivot Imqation Boom al� $40
Traffic Siqnal Standard
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns / 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 ion Tri s$20
Investi ative Fee
Reins ection Fee $20
TOTALFEE �
(minimum total fee is $20)
THIS AREA PoR INSPECTOR
I hereby certify that I inspected ihe electrical installafion described herein on the dates stated:
Special Inspection $30 per Hour E%PIREDIA94NDONFD
S iallns ion $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT
I IIII II III �I III II III II II) (I II II I�I II I�I �� (�
18435982
JIPLETED WITHIN 12 MONTHS
� ough-in Inspection Required? ❑ Yes nspection Other Than Rough-In� eady Now ❑Will Call
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ou must call the inspector when ready. Date Ready:
I certify that I am th I SED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work ai
Job Site Street Add Y .\
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pARK ROAD
�o ing Installation)
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t, Master Eledncian or Power Lii
� License Number
PHONE: (651) 490-1333
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