P - 81928REQUEST FOR ELECTRICAL INSPECTION
1 131 9 4 7 � Minnesota Board of Electricity �°'-
� r 1821 University Avenue Suite S-128, Saint Paui, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
w�n�m.electricity.state.mn s
identify the work covered by this request:
ONEW ❑REMODEL ❑ADDITION ❑REPAIR � �
GENERAL FEES utdoor Li htin Standard �$1
SERVICES 1 POWER SUPPLIES Traffic Si nal Sta�dard �$5
0 to 400 Am re �$25 Su plemental Fee C� $2�
401 to 800 Am ere �$50 Transiormers u to 10 KVA �$10
Above 800 Am ere �$75 Transtormers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su for Si ns / Outline ' Min �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service and/or Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two inspection Trips Each Dwellin Unii �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri �$20
Each S stem Device or aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinsnection Fee �$20
OTHER ADDITIONAL FEES
Li htin Retrofit �$.25 er Fixture
Center Pivot Irrigation Boom (� $40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Skes � $5
Separate Bonding Inspection � $20
Soecial Insoection � $30 ner Hour
total fee is
i herobvi certAv that I insoected the electricel inslaliafia� described
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS_ __
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Requ Date: Rough-in Inspectian Required? ❑ Yes ❑ No Inspection Other Than Raugh-In: eady Now ❑ Will Call
p� ` O You must call the fnspector when readyl Date Ready:
I ceAiiy tl�at I am the ICENSED COtJTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, or Rou[e No.) City ��� Zip Code
/ c�G .� / ? / n, � � � /— .Q , �� D . . G'�i�? 7
� Occupant
Range Fire No. County /J
v
Phone
�a �� 3 - S7i a
Address
Contractor License Number Master License
DEPENDABLE ELECTRIC, iNC.
M'�li i� r 6�tr �p 1� erfo
Geon Rapids. MN 55433
Autlwdzed Signature r, Company or Ovmer I
E&00001A-13 7/1
BOARD OF ELECTRICITY COPY
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IWSTHUCTWNS ON BACK OF YELLOW COPY