P - 77013REQUEST FOR ELECTRICAL INSPECTION ��`��
1-820-480 Q y �j4 ��
❑ Minnesota Board of Electricit �� �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �.
(651)642-0800TTYIMRS 1-800-627-3529 www.electricity.state.mn.us ���
D�nqe -using the back of t�hite copy if necessary - t�work cov�red by this request:
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GENERAL FEES ,_ Outdoor Lighting Standard @$1
0 to 400 Ampere @ $25 �
401 to 800 Am re $50
Above 800 Am ere $75
CIRCUITS / FEEDERS
0 to 200 Am re $5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIO
L' htin Retrofit @$.25 r Fi�ure
Center Pivot Irriaation Boom C� $4(
Transformers u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer I Power Supply for Signs / Outline Lighting @$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
total fee is
I inspeded the electrical installation described herein on the dates stated: �
.— � �
Special Inspection $.31 er Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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18204800
Date: Rough-in Inspection Required? ❑ Yes (�No Inspection Other Than Rough-In: ❑ Ready Now ill Call
� O 1� l� _�� You must call the inspector when ready! �' Date Ready:
I certify that I am the I
Job,Site SVeet Address
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Electrical U51ity
CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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Section Range Fire No. County �
any or Owner Pertor
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or Owner Perfortninc
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icense Number Master Elec[rician or Power Limited Technician
/ � � License Number
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