P - 79561REQUEST FOR ELECTRICAL INSPECTION
�� Minnesota Board of Electriciry =
1 Fy�O 7 9- 3 4 5 �;$ �e 1821 �niversity 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: l7L M� p ������� ��a�/ n��A�
/C I°'l-� o` J K� t/
❑NEW ❑REMODEL ❑ADDITION �'FIEPAIR �(y�y�a;� i„�� ,�jS7'�"�
GENERAL FEES Outdoor Li htin Standard �$1
SERV(CES / POWER SUPPLiES Traffic Si nai Standard �$5
0 to 400 Am ere �$25 Q Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS I FEEDERS Transformer / Power Sup for Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri �$20
Each S stem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE �,,�
3 to 12 Units �$50 Per Unit (minimum total fee is $20) �/� �
OTHER ADDITIONAL
Lighting Retrofit � $25 per Fxture
Center Pivot Irriaation Boom � S40
nnanurac�urea nome ranc �ocs ��zs I hereby cert' tl�at 1 inspected the eleclrical installa4on descn'bed herein on ihe detes steted:
RecreaGonal Vehicle Park Sites �$5 101GH1N °"T�
5e rate Bondin Ins ion �$20
S ial In �on � $30 r Hour """""�Q"0N . � � � '�
5pecial Ins ection �$.31 r Mile "�J
THIS INSTALLATlON MAY BE ORDERED DlSCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OPFICE USE ONLY
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Request D e: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: eady Now � WN CaN
You must caI11Ae inspedor when readyl Date Ready:
I certiiy that I am the LICENSED CON'fRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box or Ro e No.) Ciry Zip Code
-- �' ��" (X. �—
Section Township Range Fire fYO. County/� �
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Occupant Phone
M i.� L%n.-�i ,.,. >�.�-.� �c..n � �i �f. �' 7 �_ �91L�'
� Mailing Address (Conyactor, Company
License Number
0
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80ARD OF @LECfRICITY COPY INSTHUCTIONS �! BACK OF YELLOW COPY