P - 81829REQUEST FOR ELECTRICAL INSPECTION
.�'— � O � � ^ O � , � Minnesota Board of Electriciry
,� � �` 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
��� '�� (651) 642-0800 TTY/MRS 1-800-627-3529
www. electrici ry, state. rran. us
Identity the work covered by this request: �� / ���� �
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❑NEW MODEL ❑ADDITION ❑REPAIR Sv t�
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re�$25 0 Su p�emental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA (� $10
Above SDO Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / OWine Li htin �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re�$10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Tri Each Dwellin Unit (� $80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri �$20
Each S em Device or A ratus �$.50 Investi tive Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to �2 units �$5o Per unit (minimum total fee is $20
EaCh Additional Ur1it �$25 WF INSPECTOF USE ONLV
OTHER ADDITIONAL FEES �l/l/,(�.3'��3-0�
Li hti Retrofit �$25 r Fixture
Center Pivot Irri tion Boom �$40
Manufactured Home Park Lots �$25 I he ceroty that I inspected the electrical installa6on des�xibed herein on nie detes stated:
RecreaHonal Vehicle Park Sites �$5 � � t0�"" ��
Se rate Bondin 1 ion �$20
S ial Ins ion �$30 er Hour ��T� ��
S ecial In �on �$.31 r Mile � 3� `�%
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONIY
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Request ate: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: Ready Now � Will Cail
�� � You must call the inspector when readyl Date Ready:
I cerMy that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby requesi inspection of ihe electrir,al work at
Job Address �, Box� or Route No.) .� CAy � Z�� �^
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Section Township Range Fire No. Cou
C�' �,o� — 5� -322�
Power Suppiier Addres�., � �
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Electrical Contrador / Company N me ., Contrador License Number Master License Number
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Mailing Address (Contra or, Company or r Perfortning Insfallation) . �� �
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Authorized gnature (Contract , o ny or r P ing Installa on) ne
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Eg_pppp _�g �/7/pppp �� BOAHD OF ELECTA PY INSTRUCTIONS ON BACK OF YELLOW COPY