P - 80131� REQUEST FOR ELECTRICAL INSPECTION
' � Minnesota Board of Electricity �"°
��� 3����. � � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 �
www.electricity.state.mn. us
identify the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION Q REPAIR •
GENEAAL 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 ere (� $50 Transformers u to 10 KVA �$10
Above 800 Am re (� $75 Transfortners over 10 KVA �$20
CIRCUITS / FEEDERS Transformer ! Power Su I for Si ! Outline Li hbn �$5
0 to 200 Am re (� $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 IncAudes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS Of LESS THAN 50 VOLTS Addiiional Ins ection T' s�$20
Each S stem Device or A aratus �$.50 Investi ative Fee
ADDiTIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to t2 Units �$so Per Unit (minimum total fee is $2
EdCh Additlonal Unit �$25 FOR INSPECTOH USE ONLY
OTHER ADDITIONAL FEES ��r�, jo-2S- ` �'
Li htin Retrofit �$25 er Fixture
Center Pivot Irti ation Boom �$40
Manufactured Home Park Lots �$25 I hereb cedity that I inspeccad the electrical installation described hereu+ on nre �tes s�ed:
Recreational Vehicle Park Sdes �$5 fl01GH1N °ATE
Se arate Bondin In ' n�$20
S ial Ins 'on � $30 r Hour '"�"10N /"'� � °"'�
S ial In ion �$.31 Mile �����'"�� ��� �3
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFiCE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Roug . ady Now � Wilt Call
g' �� � Q You must call the inspector when ready! Date Ready:
I certify that I am th�tlG'ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical wak at
Job Addr�ss (Street, Box, or Route No.) Z�P �
/.3� ' �s .�� �-
Section Township Range Fire No. County
����t ���9a -s�s".�
Power Suppli r Address
Ef��eth[�t��jiCQn RBR� ' C� ' � Contractor License Number Master License Number
Lf Ci� vl_G GV �
oon Ra ids Blvd. NW /�
J�dr�(�Wicect��rn�� r Pertorming Installation)
Fnoo
Authorized Signature (Co , y or Owner rfortning I�stallation) Ptwne r��� ��
EB-00001A-13 �/1/2000 BOARD OF ELECRiICRY COPY INSTAUC710NS ON BACK OF YELLAW COPY