P - 78316REQUEST FOR ELECTRICAL INSPECTION
1 3 4 7 4�„ 4. Minnesota Board of Electriciry
` � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�ssi� sa2-oeoo TTY/MRS 1-800-627-3529 =
www.electricity.state.mn.us
Identify the work covered by this request:
❑ NEW �iEMODEL I�ADDITION ❑ REPAIR � �
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transfortners over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su for Si ns / Outline Li htin �$5
0 to 200 A re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service and/or Power Suppty up to 500 Amperes, All
ALARM, COMMUNICA710N, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$8(
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins 'on Tri s�$20
Each S stem Device or A aratus �$.50 Investl ative Fee
ADDITIONS TO THE GENERAL FEES Reins
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Unfts �$50 Per Unit
Each Additional Unit (� $25 w"'"�CTOfl �
OTHER ADDITIONAL FEES
Li hUn Retrofit �$25 r Fixture
Center Pivot I� tion Boom �$40
Manufactured Home Park Lots f� $2 I herety cenir
Recreational Vehide Park Sites � "01GH1N
Se arate Bondin I 'on � 520
FlIUL INSPECM7N
(minimum total fee is
0 4�- U ( _S 3 ?
thatlinspected the electricalinstallation described herein onthe dates stated:
/--� onre
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S ecial Ins ection �$30 er Hour
S ial In ion �$.31 r Mile �Z —� � c�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspedion Required? es ❑ No Inspection Other Than Rough-In: ❑ Ready Now Will Call
�' �� 7 You must call the inspector when [eady! Date Readv:
I certi(y that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY V
Job Address (Street, Box, or Ro No.) City
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Sechon Township Range Fire No.
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� ElecVical Conhactor / Company Name
� Mailing Address (Contractor,
or Owner Performing Insta�lation)
and hereby request inspection of the electrical work at:
Zip Code
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Phone
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Contractor License
Number
�natur tr r, p or Owner Perfortning Installation) Phone
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7/1/2000 BOARD OF ELEC7RICRY COPY INSTRUCTONS ON BACK OF YELLOW COPV