P - 82525. REQUEST FOR ELECTRICAL INSPECTION
�O � ^ � � � �� Minnesota Board of Electricity
� �� ��� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� � ,, (651) 642-0800 TTY/MRS 1-800-627-3529
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www.electncety.state.mn. us
Identify the work covered by this request: �� �� �� �� �.� ��� Cv���N��
❑NEW ❑REMODEL ❑ADDITION ❑REPAIR
GENERAL FEES Ouidoor Li htin Standard �$1
SERVICES I POWER SUPPLIES Traific Si nal 3tandard �$5
0 to 400 Am re �$25 Su lemental fee �$20
401 to 800 Am re�$50 Trensfortners u to 10 KVA �$10
Above 800 Am re �$75 Transfortners over 10 KVA �$20
CIRCUITS I FEEDERS Transformer / Power Su for Si ns I Outline Li htin �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROI, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unil �$60
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS AddRional Ins ection Tri s�$20
Each S stem Device or A aratus �$.50 Investi ative Fee
ennirinuc Tn �uF r,FUFam FFFC Reinsoection Fee �$20
3 to 12 Units �$50 Per Unit pninmiuui ivw� �a� �� v���� -- --
EaCh Addft'tonal Unit �$25 � INSVECTOR USE ONLV
OTHER ADDITIONAL FEES
Li hti Retrofit �$25 er Fixture
Center Pivot Irti ation Boom �$40
Manufadured Home Park Lots �$25 I he cerMy mat I inspected me elecUical insmllatlon aescn'bed herein «i ihe de� s�ed:
Recrea6onal Vehicle Park Sites � $5 `�"" ��
Se rate Bondin Ins 'on � $20
S ial I bn �$30 r Hour ""°L'�C°0N ��
S 'al In ectan � $.31 Mi� �� ��2'��
____ _IKI; _ I�,SIpL1./�TION MAY BE ORDERED DI$CONN�TED IF NOT COMPLETEQ_WITHIN 18 MONTHS _
FOR OFFlCE USE ONLY
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Request Date: Rough-in Inspecdon Required? ❑ Yes ❑ No Inspecdon Otl�er Than RougMln: ❑ R�dy N all
!I ��' �/ zi You must call the inspecta wtien readyl Date Ready:
i cer�iy that I am the ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the �ectrical work at
Job Address (Street, Box, o�e No.) Ciryf�„ p �P ��
�VO 6• V�a Niir �A� idLE 3
Section Township Range Fre Na. ty
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OccupaM � . Phone
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Electrical Contractor / Comp�
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Mailing Address (Contractor,
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Authorized Sianature (Contrf
�ic Co �.��
or Owner Performing Installation)
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�anv or Owner BerforminS7 Installe
ictor License Number
G�900'772
Number
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7�7/pppp BOARD OF ELECTRICRY COPY INS7RUC710NS ON BACK OF YELLOW COPY