P - 79905REQUEST FOR ELECTRICAL INSPECTION
�� O 3 3 6 8 �� Minnesota Board of Electricity -- ._ -
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota�5104
` �� � (651) 642-OS00 TTY/MRS 1-800-627-3529
www. electricity. state. mn. us
Identify the work covered by this request G���� L �`G.�IJCG%C� ��f%'1 (��/�f�.�t7
EW ❑ REMODEL ❑ ADDITION ❑ REPAIR %7 ��
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 re �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transtormer / Power Su fw 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 Suppiy up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin UnR �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addfional Ins ion Tri s�$20
Each S stem Device or ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinscection Fee � S20
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Lighting Retrofit � $.25 per Fixture
Center Pivot Irrigation Boom � $40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites � $5
Separate Bonding Inspection � $20
Soecial Insoection � $30 oer Hour
total fee is
herein on tl�e detas steted:
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FOR OFFICE USE ONLY
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Request ate: Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now ill Call
v�� o� You must call the inspector when readyl Date Ready:
I certify that I am the � LICENSED COIJTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work aY
Job Address (Street, Box, or Route No.) Cily " Tap Code
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Section Township Range Fire No. Counry ,n
Occupant�,
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Power 8uoolier
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610
Phone
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EB-OOOOtA-13 7/1/2000 ARD OF ELECTRICRY COPY INSTRUCTIONS ON BACK OF YELLOW COPY