P - 79851REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1� 17 3- 6 6 5� i82� University Avenue Suite S-128, Saint Paul, Minnesota 55104
� �a (651) 642-0800 TTYIMRS 1-800-627-3529
� www.electricity.state.mn.us '� '
Identitytheworkcoveredbythisrequest: �hanglllCJ Z��A single phase overhead
❑ NEW ❑ REMODEL ❑ ADDITION `CJ REPAIR S 2 r V 1 C 2
9-ta400 Ampere � $;
401 to 800 Amoere �
0 to 200 Amoere �
)MMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS OF LESS THAN 50 VOLTS
ystem Device or Apparatus � $.50
ADDITIONS TO THE GENERAL FEES
OTHER ADDITIONAL FEES
Lighfing Retrofit � $25 per Fixture
Center Pivot Irtiaation Boom � $40
�
Traffic Si nal StandaM � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer 1 Power Su for Si ns � Outline Li in �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unft �$8(
Additional Inspection Trips � $20
Investiqative Fee
total fee is $201 '� 3 0. 5
5 'al In ion � $30 r Hour "'"` "�'""' ' �7 �""
S ial Ins eclion �$.31 per Mile <� 22— C
THfS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 1$ MONTHS
FOR OFFlCE USE ONLY
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3f 1 1 7 3 6 6 5 9�E �i,���j ' Qr$6
Request Date: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: . Ready Now 0 Will Call
07-12-02 07-12-02
You must call the inspector when readyl Date Ready:
I ceRi(y that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical wak at
EB-OOOOtA-13 7/1/2000 BOApD OF ELECTRICRY COPY � INSiRUCT10N3 ON BACK OF YELLOW COPY