P - 78708REQUEST FOR ELECTRICAL INSPECTI€SN .
1- 3 71 �� 7 O d'�� Minnesota Board of Electriciry �..
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
, (651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. state. mn. us
Identi the work covered by this request:
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NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR �� K C 6—
GENERAL FEES Outdoor Li hfin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Amcere ��25 , 7_ _.,, c.._-'----._� �__ e.,,,. --' --
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0 to 200 Ampere � $5
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CC
�UITS, CIRCUITS OF LESS THAN 50
Each Svstem Device or Aonarah�c �
3 to 72 Units �$50 Per Unit
Each Additional Unft � $25
OTHER ADDITIONAL FEES
�h6ng Retrofit � $25 per Fixture
Center Pivot Irripation Boom � $40
Manufactured Home Park Lots � �25 �
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Supply for Signs / Outline Lighting �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Suppty up to 500 Amperes, All
Circuits and Two Ins ection Trips Each Dwellin Unit �$8f
Additional Ins ection Tri s�$20
Investi ative Fee
Reinspection Fee � $20
total fee is $20) �% 8 fp � �
I inspected the electrical instellation described herein an the dates
5 ecial In ection �$.31 r Mile � O� �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 M THS
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Request Date: Rough-in Inspectlon Required? ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now i I Call
�% �� J You must call the inspector when ready! Date Ready:
I ceRi(y that I am the,�'CCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspeCtion of the electrical work at
Job Address (Sheet, Box, or Route No.) Zp Cod�
S�6 a 3�d ST N� E `�e �� ��
Section Township Range Fire No. County
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Power$upplier
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Phone
763 - .�7/- S3� s'
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CoMractor Liwnse
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7/1/2000 BOARD OF ELECTRICITY COPY INSiRUCT10NS
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