P - 76390REQUEST FOR ELECTRICAL INSPECTION � F���
2�0 6�� 13 2 � Minnesota Board of Electricity �` � I
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` 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
(651) 642-0800 TTY/MRS 1-800 627-3529 www.electricity.state.mn us �!�
Des r�e ; qsing tqe back of the wh' e copy if necess ry- th� work covered by this request:
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GENERAL FEES Outdoor Lighting Standard $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Ampere (a� $25 Supplemental Fee $20
Above 200 Am ere a$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
L' htin Retrofit $25 per Fixture
Center Pivot Irriaation Boom (�a. $40
S ial Inspection $.31 r Mile
THI$ INSTALLATION_ MAY BE ORDERED I
I IIII II III II ��I II II� �I ��I II III II III II III I� �II I I�I
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Transformers u to 10 KVA $10
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 andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dweliing Unft @$80
' Additionat Inspection Trips @ S20
� Investioative Fee
TOTALFEE �
total fee is $20) S' �
I inspeded ihe electrical installaGon desaibed herein on the dates stated:
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COMPLETED WITHIN 12
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Date: Rough-in Inspection Required? �Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now�/ill Call
3 r��` t% � You must call the inspector when ready! Date Ready:
I certi(y that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Address ��Y '�
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Township Sectlon Range Fire No. Co ty
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Owner/Occupant Name Please Provide Two (2) Phone Numbers Including Area Code
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Electrical Utility Electrical Utili[y Address
frgctor / Company Name Contractor License Number nnaster eiectncian or row
� � License Number
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ing Address (Contrac[or, Company or Owner Perfortning Installatio/n�)
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hypy'e Signature (Contractor or Owner Perfortning Installation) Piease Provide Two (2) Phone Numbers Inc
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