P - 79835REQUEST FOR ELECTRICAL INSPECTION
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� Minnesota Board of Electricity
1� 2 2 2� 2 61 �e 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
'��-- (651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. state. mn. us
IdentiTy the work covered by this request:
❑ NEW ❑ REMODEL �I4DDITION ❑ REPAIR � p fe� �- ZTJ— 7 S �
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic 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 S00 Am ere �$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 andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING CircuRs and Two Inspection Trips Each Dwellin Und �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Add'dionai Ins ion Tri s�$20
Each S stem Device or tus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins 'on Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$5o Per Unit (minimum total fee is $20) ��%+
EaCh Additional Unit �$25 � wn n+saecron use aar
OTHER ADDITIONAL FEES �� _ ���� � ,
Li htin Retrofit �$25 er Fixture
Center Pivot I ' a6on Boom � $40 /t(N. �-G�F-� � �
Manufactured Home Park L.ots �$25 I her�y ' tliat I inspecled the electrical installauon described herein an Ihe dates stated:
Recrea6onal Vehi�e Park Sftes � $5 � "01GN" °�'�
Se arate Bondin Ins 'on � $20 �% �
S cial In ion �$30 Fbur �"�"""a' - J °"'�
S ial Ins ion (� $.31 Mile =�"Y' °
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__ __ THIS INSTALLATION__ MAY BE_ORDERED DISCONNECTED IF NOT CO PLETED WITHIN MONTHS
FOR OFRCE USE ONLY
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Request Date: Rough-in Inspec[ion Required? ❑ No Inspecdon Other Than Rough-In: ❑ Ready Now � Will Cell
��� Z� You must call the inspector when ready! Date Ready:
I certify that I am thei�.L(�ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection�of the electrical work at:
Job Address (Street, Box, or Rou[e No.) City Zip Code
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Section Township Range Fire No. Co ty
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Power Supplier Address
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'cal Corrtractoq/ Company Name ConVactor Ucense Number Master License Number
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Maili�re�s"(Contractor, Company or Owner Performing Installation)
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Authorize Sign re(Contractor, ny or r Perfortning Instellation) hone
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E tA-13 7/1/2000 BOApD OF ELECTHICRY COPY INSTRUCTIONS ON BACK OF YELLOW COPY