P - 77404REQUEST FOR ELECTRIC�L INSPECTION � � ��
1� 8 6 6- 7 5 5� Minnesota Board of Electricity �(?Q� —��� �- � �
1821 University Avenue Suite 5-128, Saint Paul, Minnesota .�.�
(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:
SE-RVtcE CHltNCs�
/
� Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CANTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADD�TIONS TO THE GENERAL FEES
2 Units @ $50 Per Unit
Additional Unit @ $25
FEES
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irrigation Boom @ $4(
Manufactured Home Park Lots (� �
Outdoor Lighting Standard
Traffic Sianal Standard C�
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns / Outline Li htin $5
ONE & 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 ection Tri s $20
Investi ative Fee
Reins ction Fee $20
TOTAL FEE
(minimum total fee is $20) ��. S
THIS AREA FOR WSPECTOR USE ONLV
I hereby certi(y ihat I inspected the elecVical inslallation described herein on the dates stated:
Special Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED
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WITHIN 12
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I�I Ilill I1i�i li��i Illll lllli IIIII III� II� I�
1866755�
Date: Rough-in Inspection Required? ❑ Yes o Ins
�^ w/O� pection Other Than Rough-In: ❑ Ready Now�il� Call
l� You must call the inspector when ready! Date Ready:
I certity that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: