P - 81990REQUES7 FOR ELECTRICAL INSPECTION
1 12 3 8 8 2 Minnesota Board of Electricity —'
� � ��� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity. state. mn. us
Identify the work covered by this request: •_ • ���/ ^��� •
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❑NEW ❑REMODEL ❑ADDITION ❑REPAIR �J�~��' �'�
GENERAL FEES Outdoor Li htin Standard �$1
SERVlCES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re @$25 Su lementa! Fee �$20
401 to 800 Am re �$50 Transformers u to 1Q KVA �$10
Above S00 Am re (� $75 Transformers over 10 KVA �$20
C CUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 A re �$5 ONE & lW0 FAMILY DWELLINGS, EACH UNIT
Above 2W Am re �$10 includes the Service and/or Power Suppty up to 500 Amperes, AII
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two lnspection Tri Each Dwelfin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins 'on Tri �$20
Each S stem Device or paratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE r'!1
3 to 12 Units �$50 Per Unit (minimum total fee is $20) �`�
EdCh Additi0f181 Unit �$25 fIXi INSPECfOR USE ONLY
OTHER ADDITIONAL FEES �� 7^2J� c1
Li htin Retrofit �$25 r FuRure
Center Pivot Irri aUon Boom �$40
ManUfaclured Home Park Lots �$25 L' :�'� .. � I herebv certiN that 1 inspected the electrical installation descnDed herein on Me dates stated:
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Special Inspection � $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS __
FOR OFFICE USE ONLY
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Re i at Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-In: eady Now Q�II Call
You must call the inspector when ready! Date Ready: �
I certify that I am the�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Address (Street, Box, or te I�o. Ciry � Zp Cade
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Section Township Range Fire No. County
Occupant (1 y,� „C./l l �' f'l �/ 1/�(�-� Phone � J( G�� ���
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Power Supplier Address
Electric ontractor / Company Name
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Mailing Add (Contractor, Compan or Owner Perfortning I
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Authorized Sign Contractor mpany or Owner Pe m
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EB-OOOOtA-13 7/1/2000
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80AHD OF ELECTRICRY COVY
Master License
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INSTpUC710NS ON BACK OF YEI.LOW COPY