P - 78302REQUEST FOR ELECTRICAL INSPECTION
1 3 4 7. 3 5 3 Minnesota Board of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
. �ssi� sa2-osoo TTY/MRS 1-500-627-3529 - _
www. electricity. state. mn. us
Identify the work covered by this request:
❑ NEW ❑ REMODEL BtTION
GENERAL FI
SERVICES / POWER SUPPLIES
0 to 400 Am re�$25
401 to 800 Am ere �$50
Above 800 Am re � $75
CIRCUITS / FEEDERS
0 to 200 Am re �$5
Above 200 Amcere � $10
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❑ REPAIR �' � v � ' r � G'�
:S Out r Li h6 Standard �$1 ' �� '
Traffic Si nal Standard � $5 �
Su lemental Fee � $20
Transtormers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transfortner / Power Su I for Si ns / Outline Li hti �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
iNTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additionai Ins ion Tri �$20
Each S stem Device or ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE � j
3 to �2 Units �$5o Per Unit (minimum total fee is $20)
Each Additional Unit � $25 °� "� 0N1Y
OTHER ADDITIONAL FEES � _� ���
L' htin Retrofit �$25 r Fixlure v� �/Nf '�L�
Center Pivot I' ation Baom �$40 �_? � GtF
Manufactured Home Park Lots �$25 i hereb cert' that 1 inspected t electrical installation described herein on the dates stated:
Recreational Vehicle Park Sites �$5 �1C+H IN on�
S rate Bondin In ion � $20 6k.< � � • ��- /t -O
S ' I 'on � $30 r Hour """`��b" �7 , v °ATE�
S ial In ' n�$.31 r Mile (� '�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED iF NOT COMPLETED WITHIN 18 dIAONTHS
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
You must call the inspector when ready! Date Ready:
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY � OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
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Section Township Range Fire No. County
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Po Sup lier Address
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Electrical ConVac[or / Company Name Contractor License Number Master License Number
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Mailing Address (Contractor, Company or Owner Perfortning Installation)
Authorized Signature (Contractor, Company or Owner Perfortning Installatlon) Phone
EB-OOOOtA-13 7/1/2000 BOMD OF ELECTRICRY COPY INSTRUCTpNS ON BACK OF YELLOW COPY