P - 78289_ - - ----
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity �
1� 2 7 6� 7 q, 7� 1821 University Avenue Suite. S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS t-800-627-3529
www. electrici ty. state. mn. us
Identify the work covered by this request:
❑ NEW REMODEL ❑ADDITION ❑ REPAIR k � �' � �� �� d��
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES I POWER SUPPLIES Tra(fic Si nal Standard �$5
0 to 400 Am ere �$25 Sup lemental Fee �$20
401 to 800 Am re �$50 Transfamers u to 10 KVA �$10
Above 800 Am ere C� $75 Transiormers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Ouiline Li htin �$5
0 to 200 Ampere @$5 / ONE 8 TWO FAMILY DWELLINGS, EACH UNfT
Above 200 Am ere �$10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Ins tion Tri s Each Dwellin Unit (� $SO
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional In ion T' �$20
Each S stem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Rein 'on Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE .�
3 to 12 Units (� $50 Per Unit (minimum total fee is $20)
Each Additional Unit �$25 F0"'"�T0P1�E 0N1Y
OTNER ADDITIONAL FEES
Li htin Retroffi �$25 per Fixture
Center Pivot Irri ation Boom (� $40
Manufactured Home Park Lois (�J $25 I hereby cerMy that I inspected the electrical installation described herein on the dates stated:
Recreationai Vehicle Park Sites � "010H �' DA1E
Separate Bondi Ins ction (� $20
S ial Ins ion � S30 r Hour �"'SPC�70" � °"'�
S ial Ins ection (� $.31 er Mile �` Z"�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFlCE USE ONLY /�\ ' ' ���
i Illlil flill �IIII IIIII 11111 iilli Illll lllfl IIII illl �(�
�E 1 Z 7 6 7 4 7 1 3E , l/'�/�, �/r` /"'1/ / `) $ '"''S`�
�C(�CJ7 �J (l7oC
Request Date: Rough-in Inspection Required7 ❑ Yes �No Inspection Other Than Rough-In: ❑ Feady Now� Will Call
����1 You must call the inspector when ready! Date Ready:
I certity that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection ot the electrical work at:
EB-OOOOtA-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY