P - 80121REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board ot Electricity �
� � 3� 2� 1 O O =��° 1821 University Avenue Suite S-128, Saint P�ul, Minnesota 55104
��°'� (651) 642-0800 TTYIMRS 1-800-627-3529
�
www.electricity.state.mn.us
Identity the work covered by this request: / / C�� /J��� �
❑ NEW ❑ REMODEL O ADDITION PAIR ��� �� p � �� � �eYl�1 °�Q � J ��
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 � 30 �J Su lemental Fee �$20
401 to B00 Am re �$50 Transiormers to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transfortner / Power Su for Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Suppry up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspeetion Trips Each Dwelli Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20
Each System Device or Apparatus ��-5n Investiaative Fee
ADDITIONS TO THE GE�
TIFAMILY DWELLINGS (PER UNI�
3 to 12 Units �$50 Per Unit
Each Addftionai Unit � $25
FEES
total fee is
Center Pivot Irri ation Boom �$40
ManufBCtufed Home Park Lots �$25 I hereby ' that I inspected the electrical installatlon described herein on the dates s�ed:
Recreational Vehicle Park Sites � $5 "01"" "' �'�
Se atate Bondin In 0$20
S ecial Ins ion C� S30 Fbur A`""'�T0"' ��
S ial I� edion �$.31 Mife "'^- —Z r-oti-�
THIS INSTALLA710N MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspec[ion Required? ❑ Yes o InspecUon Other Than RougMln: eady Now 0 wil Call
�" " 0 You must call the inspector when readyl Date Ready: '�� Q�
I certiiy that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecGon of the etectricai wodc at
Job Address (Street, Box, or Route No.) City ZP �
o .S-�t ve �, rr ' e
Section Township Range Fire No. County
Occupant �
► vi So v�. '
Power Supplier Address
i( C� %
Electrical Contractor / Company Name
�hOK l�
Phone
76_�- s �� 733
Master License
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or Owner Perfortning InsTallation)
v ` S f��c e�r�' S".s" 13 2-
pany or Ovmer Perfo ' g Installati ) Phone
763-7$'0 -S9 Zs'
AIiD OF ELECTNICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY