P - 75826c ❑ REQUEST FOR ELECTRICAL INSPECTION � �
1°� v�- 7 4�� Minnesota Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 i
(651) 642-0B00 TTY/MRS 1-BOOdi27-3529 www.edectricity.sdate.mn.us
Desaibe -using tl�e back of the white coPY if n�ssary - the work covered by this requ�t:
R. �1 � IZE W 1 R�
GENERAL FEES Outdoor Lighting Standard @$1
SERVICES / POWER SUPPUES Traffic Si Standard @$5
0 to 400 Am re $25 Su plemental Fee @$20
401 to 800 Am re$50 Transformers u to 10 KVA $10
Above 800 Am re $75 Transformers over 10 KVA $ 2Q
CIRCUITS / FEEDERS Transformer / Pawer Su I for Si s/ Outl'me Li Min $5
0 to 200 Am re ONE 8 TWO FAMILY DWELLINGS, EACH UNR
Above 200 Am re$10 Includes the Servic� and/or Power Supply up to 5�0 Amper�s, All
ALARM, COMMllNICATION, REMOTE CONTROL, SIGNALING �rcuils end Two Inspedion Trips Each Dwelling Unit @$80
CIRCUITS, CIRCURS OF LESS THAN 50 VOLTS AddiUonal Ins ' n T' $20
Each S m Device or paratus $.50 Inv�tigative Fee
ADDITIONS TO THE GENERAL FEES Reins 'on Fe.e @$20
MULI7FAMILY DWEWNGS PER UN TOTAL FEE
3 to 12 Units @$50 Per Unft (minimum total fee is $20) �� ��
Each Add'Iflonal Unit @ $25 T�^�^�°'�PECTOR��Y
OTHER ADDRIONAL FEES
LI Ming R2hofR @$.25 r Fbdufe I hereby cerd(ythffi I inspeded fhe eledricel Ir6sta0adan desalbed herein nn fhe datas sls0ed:
Center Pivot Irtigation Boom $40 �" �' �T�
Manufectured Home Park LoG� $25 � �Q`
Recreational Vehicle Perk Sit� $5 � °1�0T10N ��
Se Bondin Ins $2(I — — c�
Special I� on (d� $30 per Hour °�D/ �
S Ir�specUon $.37 per M1e
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
fi0R OFFICE USE ONLY � /� �tj
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A � � g spectlon Repufred? �es ❑ No Inspecdon Other Than Rough-In: 0 Ready Naw Cap
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(� � You must call the inspector when dyi Date Ready.
I certify that I am the LICENSED CONTRACTOR ❑ COMPAWY ❑ OWNER artd hereby request inspection of the elactrical work at
Job Sfte Street Addr�s � �/ v� �� I�
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T�$wP Sactlon Range Flre No. County
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Owner/OxuPant tdeme Please Provida Twa ( Phorre Numbe�s Irtclud(ng Area Code
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Eledrical t�tY Electrical Uti6ty Address
Co dor! CumPenY Wame Contrador Licen� Number Master Electric�n or Power Limfted Technldan
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MatMg Addr�s (Co�or, Company or Owner Performmg Iristallation)
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A��� SlgnaU� ntractor or Oamer PerFormhig InslallaBon) � ease Provide Tvro (2)�one Numbera Including Area Code
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aI3TRUCf10NS ON BACK QF YELLOW CQPY BOARD OF EIECTRICITY COPY Fa.nmm� e_� s n� omie