P - 79880REQUEST FOR ELECTRICAL INSPECTION
1 � O� ��� m Minnesota Board of Electriciry —
� � ��m 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� (651) 642-0800 TTY(MRS 1-800-627-3.
www.electricity.state.mn.us '' `
Identity the work covered by this request: ,/►
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR .
i%i/ �
GENERAL FEES Ou r Li htin Standard �$t
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 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$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 �$20
Each S stem Device or ratus �$.50 Investi tive Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$50 Per Unit (minimum total fee is $
Each Additional Unit � $25 F°"'"Sr�cr°" "s� °'bY
OTHER ADDITIONAL FEES � � /� � �
Li htin RetrofR �$25 er Rxture �
Center Pivot Irri Cron Boom �$40
Ma11uf8Ctufed HOrt12 PaFk LOtS �$25 I hereby certify that I inspected the electrical installatlon described herein on the dates stated:
Recreational Vehide Park Sites �$5 R01GH1N .' °�'�
Se rate Bondin Ins ec6on (� $20
S ial Ins ecGon �$30 r Hour �'"""'uPEO"0N C! DA1E
S ecial ins ection �$.31 er Mile /� 2���
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFlCE USE ONLY
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Requ Date• Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough- • eady Now 0 Will Call
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� 4� You must call the inspector when ready! Date Ready:
I cerUTy that I am ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical worlc at:
Job Address (Street, Box, or Ro No.) Ciry Z�P C� �
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Section Township Range Fire No. County
Occupant Phone
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Installallon)
Autl�orized Signature (Co , Com er ing Installation) Phone
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EB-OOOOtA-13 7/1/'2000 BOAND OF ELECTRICfiY COPY IN37AUC710NS ON BACK OF YELLOW COPY