P - 79498REQUEST FOR ELECTRICAL INSPECTION
1� 2 7 9 2 3 4 '° � Minnesota Board of Electriciry -
� e�Ee 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
, `�ae��:�` (651) 642-0800 TTY/MRS 1-800-627-3529
-�.......
www.electracaty.state.mn.us
Itlentity the work covered by this request: W i2E r(,� (ZN f} (�' :,
❑ NEW ❑ REMODEL ❑ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard �$i
SERVICES / POWER SUPPLIES Treffic Si nal Standard �$5
0 to 400 Am ere (� $25 Su lemental Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH 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 ection Tri �$20
Each S stem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$5o Per Unit (minimum total fee is $20)
Each AddiGonal Unit �$25 WR INSPECTOR USE ONLV
OTHER ADDITIONAL FEES
Center Pivot Irri atbn Boom �$40 �
Manufactured Home PaAc Lots � 1 hereby ce � that 1 inspeded tl�e electrical ir�tallation described herein on ihe dates s�ed:
Recreational Vehicle Park Sites � AOUGH IN �"�
Se arate Bondin Ins ion �$20
S ecial Ins ection �$30 er Hour "'1"'�sPE°"°" �AT�
S ial Ins ection �$.31 er Mile '�'_'�"'�� �Z— s��—
THIS INSTALLATION MAY BE ORDERED DISCONNECTED COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Ves No Inspection Other Than Rough-In: Ready Now ❑�II Call
(p ��� d Z You mus[ call the inspeclor when ready! Date Ready:
I certify that I am ihe (�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecction of the electrical work at:
Job Address (Strest, Box, or Route No.) C'dy Zip Code
�s6s- y�sr-�E F�e�pc.E
Section Township Range Fire No. County
� �16 l�
OccupaM Phone
Naro/�Sorehsa.� - �63—�d'Y- 7/G �
Power Supplier Address
Electrical Contrador / Company Name Contractor License Number Master License Number
s�'G�c-�l�ic Cfto oY
Mailing Address (Contrador, Company or Owner PerfortningJnstallation)
S7� �'7� u Nu/ Z��� . »�h. ,SS39�
Authorized Signature (Contractor, Company or Owner PeAortning Instal tion) Phone
.�,�tz•� _ 7d3 ��''�ct/D
EB-00001A-13 7/1/2000 BOARD OF ELEC7RICRY COPY INSTRUCTIONS ON BACK OF YELLOW COPY