P - 78789REC�UEST FOR ELECTRICAL INSPECTION
1 � � � � � � � � � Minnesota B�ard of Electricity
1821 Universi Avenue Suite S-128, Saint Paul, Minnesota 55104
��e°. � � � (651) 642-0800 TTY/MRS 1-800-627�529
www.electricity.state.mn.us
Identity the work covered by this request:
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES tra�c Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transfortners u to 10 KVA �$10
Above 800 Am re�$75 Transformers over 10 KVA �$20
CIRCUITS I FEEDERS Transformer / Power Su for Si ns / OuNine Li htl �$5
0 to 200 Am re�$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes fhe Service andlor Power Suppty up to 500 Amperes, All
ALARM, COMMUNICA710N, REMOTE CONTROL, SIGNALING � Circuits and Two Inspeclion Trips Each Dwellin UnR �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additlonal In ion Tri s�$20
Each S stem Device or A ratus �$.50 Investi tive Fee
ADDITIONS TO THE GENERAL FEES Reins 'on Fee �$20 TOTAL FEE
MULTIFAMILY DWELLINGS PER UNI r
3 to 12 Units �$50 Per Unit � �: . v o (minimum total fee is,(�!0) •
Each Additional Unit �$25 `°A �"5`ECro" u� ora� 9� - t
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OTHER ADDITIONAL FEES
' htin Retroffi � $25 Fudure
Center Pivot I' ation Boom �$40
Manufaclured Home Park Lots �$25 I hereby certity tl�at I inspected tl�e electrical iretaNation described herein an 1he de� s�d:
qOUfiH IN ��
Recreational Vehide Park Siles � $5
S rate Bondi Ins 'on � $20 �,,��
S ial Ins 'on �$30 r Hour Fl"�` �"�`�01 .�j+
S'al In ' n�$.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS_
FOR OFFICE l�E ON�Y /
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Request Date: RougMin InspecUon Required? ❑ Yes No Inspection OHier Than Rou9h'�rc ❑ ReadY � ��� �%all
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_ Q 3 You m�t call the inspector when ready! Date Ready: ' �•�%�
I certi(y that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecdon of the electrical nrork at:
Job Address (Street, x, or oute No.) City, Zp Code
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Section Township Range Fire No. �1Y
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Power plier Address
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IA-13 7/1/2000 � BOARD OF ELECTRICITY COPY .INSTNUC'IlOt�1S WI BACK OF YELLOIN COPtl