P - 80157REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity °' �
�� 2 6 O� 8 7 2 � f 1821 University Avenue Suite 5-128, Saint Paul, Minn a 55104
� (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn. us
IdentiTy the work covered by this request: .
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR V V� r"�% C.�Y V>> "" �
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee (� $20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transfortner / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
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 ion Trips Each Dwellin Unit �$8C
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addftional Ins ion Tri (� $20
Each S stem Device or A ratus �$.50 Investi ative Fee
ADOITIONS TO THE GENERAL FEES Reins ection Fee �$20
MU�TIFAMILY DWELLINGS PER UNI OTAL FEE
3 to 12 Units � S5o Per Unit (minimum t tal fee is $20'
OTHER ADDITIONAL FEES
Li htin Retroffi �$25 er Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots � I
Recreational Vehicle Park Sites _ '
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.S ecial Ins vV.ion �$.31 per Mile � /%L� –�— l��'��
THIS INSTALLATION MAY BE ORDERED DISCONNEC OT OMPLETED WITHI 18 MONTHS
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f FOR OFFICE USE ONLY
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RequySt t Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: eady Now ❑�II Call
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(J You must call the inspecta when readyl Date Ready:
I ceRify at I am the ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of tlie elecirical wak at
Job (Sh t, Box, r oute N.) City Zip�S�� �
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'on Townshio Ranae Fire No. County
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Address
Electrical RICHM�y��NS EI.EC-1�''•
Es! VALLEY HTG � �
Mailing Ad ress (Cq�t��r1��y ng Install
CFiYSTAL. MN 55429
Aufhorized Signature (Cont e erf ing h
E6�00001A-13 7/1/2000
Contractor LicBnse Nu ber
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ELEC7AICITY COPY
Master License
INSTpUCTWN$ ON BACK OF YELLOW COPY