P - 75818� REQUEST FOR ELECTRICAL INSPECTION
1����- 6 6 5 0 Minnesota Board of Electricity �/�j�. ��
1821 University Avenue Suite S-128, S`ainflfauf�Ainnesota 04
(651)642-OSOOTTY/MRS 1-800-627-3529 www.edectricity.state.mn.us �' "�
Descn'be -usmg �e back of ffie white �py'rf r�ecessary - the arork covered by this request:
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G ERAL FEES Outdoor Lightin Standard @$1
SERVICES / POWER SUPPLIES Traffic Signal Standard @$5
0 to 4Q0 Am re@$25 Supplemerital Fee @$20
401 to 800 Am re$50 Transfortners u to 10 KVA $10
800 Am re$75 Transformers over 10 KVA $ 20
CI ITS / FEEDERS Transformer / Power Su I for Si ns / OWine Li htin $5
0 to 200 Am re$5 ONE 8 TWO FAMILY DbYELLINGS, EACH UNR tn
A6ove 200 Am re $10 Includes the Service and/or Power Supply up to 500 Amper�, All ,.7v
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Cfrcuits and Tuvo InspecUon Trips Each Dwe�ing Unft @$80 �
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addfional Ins 'on Tri $20
Each Svstem Device or Aooaratus (�a $.50 Investiaative Fee
Each Add�tional Unit @ $25
OTHER ADDI170NAL FEES
Lighti� Retrofit @ $.25 per Fodure
Center Pivot Irriaation Boom an $40
�viw�ree I ryO �a
total fee is $201 X �
I hereby certify fhat I ins� the electrical installatlan desa�bed herein on tlre dates �ffied: �
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Special Ins 'on @ $.31 per M�e
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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I I�� �I (I� � lu I� � II �I r) III U AI II IU �W IUU �'�6
18966655
��' Rou h-In Ins on R ufred9 es ❑ No Ins
//r � 0-� f g pedi eq pectlon Other Than Rough-In: 0 Ready Now ❑ W@ Ce0
5 You must cell the inspector when ready! Date Ready:
I certify that I am the�CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspedion of the electrical work at
Job Site Street Addr�s /f
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Toxmship Section Rarige Fire No. County
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Owner/q� pant Name 4 C .. ����e y Please Provide Two (2) Phone Plumbers Inciuding Area Code
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or Owner I
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Contracror License Number Master 'cian or Prnxer Limited Tech
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wumo� s� re �c;o r or c�wner Nertorm�ng Iauon) ' Ple�e Provide Two (2) Phorre Rlumbers Including Area Cade
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