P - 76437� REQUEST FOR ELECTRICAL INSPECTION '�
1�� 1 dJ � 5 9 7� Minnesota Board of Electricity �-
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
-, (a� (651)642-0800TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
Describe -using the back o� whfte copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Li htin Standard $1
SERVICES I POWER SUPPLIES Traffic SiQnal Standard (a� $5
� Above 800 Ampere (� $75
CIRCUITS I FEEDERS
0 to 200 Am ere $5
Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL F
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
L' h6n Retrofit $25 per Fi�ure
Center Pivot Irri ation Boom $40
Manufactured Home Park Lots a$25
Recreational Vehicle Park Sites $5
Se arate Bondin Ins ection $20
Special Ins ection a$30 per Hour
5 ecial Ins ection $.31 er Mile
5 INSTALLATION MAY BE ORDERED DI�
Illll lllll lllil �lll llIII IINI IIIII IIIII ��` i�ii ���
19755974
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns I Outline Li htin $5
NE & TWO FAMILY DWELL�NGS, EACH UNIT
Includes the Service andlor 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 ion Fee $20
TOTALFEE
(minimum total fee is $20) �J
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I hereby certiry that I inspected the electrical installation described herein on the dates stated:
IF NOT
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12 MONTHS
Date: Rou h-in Ins
g pection Required? ❑ Yes o Inspeciion Other Than Rough-In: � Ready Now ill Call '
3�' l0 �`� You must call the inspector when ready! Date Read
y:
I certify that I am the I$�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at