P - 79822REQUEST FOR ELECTRICAL INSPECTION
� � � � � � � Minnesota Board of Electricity �
� � g� 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
� ��� (651) 642-0800 TfY/MRS 1-800-6273529 ��
www.electricity.state.mn.us � �
IdentiTy the work covered by this request:
❑NEW REMODEL ❑ADDITION ❑REPAIR � �(/�I.,��V I �S[ 7 Z 7-7 8 g�
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 8� Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CUITS / FEEDERS Transformer / Power Su I for Si ns / Outline L' htin �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACN UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri �$20
Each Svstem Device or Aooaratus �$.50 Investiqative Fee
total fee is
Li htl Retrofd �$.25 er Fbcture
CeMer Pivot I' ation Boom �$40
ManufaCtured Home Park LOts �$25 I he ce' that I inspected the electrical installatlon described herein on tlie detes stated:
Recreational Vehicle Park Sites � $5 "0�"" °�'�
Se arate Bondin Ins tion �$20
S'al I ion �$30 r Hour Fl""""�`"10N �',r �� °A7E
S ecial Ins ection �$.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFRCE USE ONLY
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Request D�t �� Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now WIII CaN
You must call the inspector when ready! Date Ready:
{ certiiy ri�at I am tt�e LICENSED CONiRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work ai
Job Address (Street, Box, or Route No.) C' Z�P �
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Range
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Elect�l Cmtwctar.I.Comp�nr`pIa�ECT.� �i�Ci. Co dw License Number Master License Number
AINr 1'11tz
�3562 CENTr�AL AVE. N.E.
Mailing Addr er PeAortning Installation)
Authorized S re(C cto m er Pertormin stallation) Phone
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E&OOOOtA-13 7/1/2000 � . BO RD OF ELECTRICITY COPY IN37AUCT10NS ON BACK OF YELLOW COPY