P - 79669REQUEST FOR ELECTRICAL INSPECTION
' Minnesota Board of Electricity o-�"
1� 2 4 2-14 7�9 � i8z� ����e�s,ry A�e��e Su�te S-,2a, Saint Paul, Minnesota 55104
� e° �= (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us '� �
identify the work covered by this request: ,p��� A�� _ / `� ���
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❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR �� �� � � ,�C� � ��
0 to 400 Am ere �
401 to 80Q Am re
Above 800 Am ere
CIRCUITS / FEEDERS
0 to 200 Amoere �
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each AddRional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 er Fixture
CeMer Pivot Irri ation Boom �$40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites � $5_ _
Traffic Si nal Standard (� $5
Su demental Fee (� $20
Transformers u to 10 4CVA �$10
Transtormers over 10 KVA � $20
Transformer / Power Su i for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service and/or Power Supply up to 500 Amperes, Ail
CircuRs and Two Inspection Trips Each Dwelling Unit �$8C
Additional Inspedion Trips � $20
Investigative Fee
� Reinsoectbn Fee � $20
total fee is
I herebv certifv ihat I insoected the electrical instaliation described herein an tlie dates stated:
Special Inspectlon �$.31 per Mile I I
THIS INSTALLATION MAY BE ORDERED DISCONNECTE
FOR OFFICE USE ONLY
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You must call the inspector when ready!
t certiiy that I am the ❑ LICENSED CON'fRACT p��
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ical Contractor / Company Name
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ig Address (Contractor, Company or Owner Pertorming
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irized Signature ntrac o ny or Owner Perfon
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91Ad3 7/1/2000 �
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HIN 18 MONTHS �
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J No I Inspection Other Than Rough-In: U Ready Now �J Will Call I
Date Ready:
❑ OWNER and hereby request inspection of the elecVical work at:
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BOARD OF ELECTRICRY�COPY
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Master License Number
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INSTpUCTIONS ON BACK OF YELLOW COPY �