P - 78317REGlUEST FOR ELECTRICAL INSPECTION
Q%Q Minnesota Board of Electricity °' y``
1� 3 G 6� J I V 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.st .m us
Identify the work covered by this request: ��� C�� �'
NEW ❑ REMODEL ❑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 ere �$50 Transfortners u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transfortner / 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 re �$10 Ir�cludes the Service andlor Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$60
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S stem Device or ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins 'on Fce �$20
MULTIFAMILY DWELLINGS PER UNI TOTAI FEE
3 to 12 Unns �$5o Per Unit (minimum total fee is $20) �
Each Additional UnR �$25 ra+ ir+srecron use on�v
OTHER ADDITIONA
Li htin RetrofR �$.25 r Fixture
CeMer Pivot I' ation Boom �$40
Manufactured Home Park Lots �$25 I hereby certity that I inspected the electrical inslallafion described herein on the dates stated:
Recreational Vehicle Park Sites �$5 P01Ci �' °"'�
Se arate Bondin I 'on � $20
S ial In 'on �$30 r Hour FlNAL INSPECl10N o�,�
S iai In on �$.31 r Mile � G�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
�����
I111111 fIIN ilfll 1i111IIIII illll 111111i111I{ll IIII _
�E 1 3 O 6 9 7 8 6�E ' �� ''� �. s�
�; ��, - � �';, � � �
Request Date: Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now ill Call
'� You must call the inspector when ready! Date Ready:
I ceRify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
r�
Job Address (Street, Box, or Route No.) City Zip Code
Co � 5� �` � F sLr�DG�' l-�
Section Township Range - Fire No. ounty
� � Ul�
Occupant ' Phone
�'!�1 t�1 - o� j - C7
Power Suppli r Address !
t.�- r/ ��S ? �� ,(! ti �
Electrical Contractor / Company Name Contrador License Number Master License Number
r' 1 U�ID�S� �v3 3 � S�
Mailing Address (Conlrador, ompany or Owner Performing Installation)
� � S� �� %` SR ��T (' � C•. C� �
uthorized Signature (Contrector, Company or Owner Performing Installation) Phone
l�S`7f���
EB-OOOOtA-13 7/1/2000 BOARD OF ELEC7RICRY COPY INSTRUC710NS ON BACK OF ELLOW COPY