P - 78514> REGIUEST FOR ELECTRICAL INSPECTION
�; 3 4 7 4. O 4 � Minnesota Board of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�'����� (651) 642-0800 Tl'Y/MRS 1-800-627-3529
www. electrici ty. state. mn. us
IdentiTy the work covered by this request: �n���� �!/� j� � G� /.T-. � /
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❑NEW ❑REMODEL �ADDITION EPAIR
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traific Si nal Standard �$5
0 to 400 Am re�$25 Su lemental Fee �$20
401 to 800 Am re�$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Trensformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su for S' ns / Outline L' hti �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNR
Above 200 Am re�$10 Includes the Service andlor Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Tri Each Dwelli Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional In ction Tri �$20
Each S stem Device or A ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAI FEES Reins ion Fee �$20
MULTIFAMILY DWELLINGS PER UN TOTAL FEE
3 to 12 Units (� $50 Per Unit (minimum total fee is $20
Each AddlUOnal Unit � $25 F0fl1N�`�0fl "� °NLV ?%
OTHER ADDITIONAL FEES �6�, /_Q�q CJ�/' S
Li Min Retrofit �$25 r Fixture � �
Center Pivot Irri ation Boom C� $40
Manufactured Home Park Lots $25 I hereby cerMy that I inspecied tlre electrical insrallaiion described f�ere� on the deres smted:
Recreadonal Vehide Park SRes $5 fl01�"" �h
Se rate Bondin Ins ection (� $20
S ial Ins 'on (� $30 er Hour """"�"'"0N �'�
S ial Ins 'on �$.31 r Mile �a�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPL TED WITHIN 18 MONTHS
� FOR OFFICE U8E ONLY
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Requ Date• Rough-in Inspection Required? ❑ Yes � No Inspection Other Than Rough-In: ❑ Ready No ill Call
You must call the inspector when ready! Date Ready:
I rti(y that I am the�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) Cily Zp Code
I � ' ����3
Sect n Township Ra e Fire No. Coun
v Ndd
OccupaM � � Phone
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License Number � Master
or 6wner Perfortning InslallaGon) I P�ne
I (�/1��;/T��!'�% 7 I
BOARD OF ELECTAICRV COPY �X'�STRUC710N3 ON BACK OF YELLOW COPY