P - 79869REQUEST FOR ELECTRICAL INSPECTION
1_ �� � A^ ti' Minnesota Board of Electricity
� � L� � �; 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
���v� e (651) 642-0800 TTY/MRS 1-800-627-3529
(j �� www.electricity.state.mn.us
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IdentiTy the work covered by this request:
❑NEW EMODEL ❑ADDITION ❑REPAIR �b S� � 6 / " � �
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su plemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere � $75
�UITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am re � $10
RM, COMMUNICATION, REMOTE CONTROL, SIGNALING
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAI FEES
Transformers over 10 KVA � $20
Transfortner / Power Su for Si ns / Outline Li htin (� $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$8C
Additional Insoection Trips (� $20
3 to i2 Unfts �$5o Per Unit (minimum total fee is $20)
Each Additional Unit �$25 PoH IM6PECTOIi U E ONLY
OTHER ADDITIONAL FEES �X~' • s rGR
Li htin Retrofit �$25 r Fixture
Center Pivot I' ation Boom �$40 L%�A!�! .
Manufactured Home Park Lots �$25 1 he ce ' ma� I inspected the elechi�Ms� reih an t1� datas sta�d:
Recreational Vehide Park Sites �$5 R01GN" DA7E
Se rate Bondin In ion �$20
S ecial Ins 'on �$30 r Hour Fl""` "'�f0" �G / °A7E
S ecial Ins ection �$.31 r Mile ` (V ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY .
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Reques�Date:� /`. � Rough-in Inspection Required? ❑ Yes Inspection O[her Than Rough-In: ❑ Ready N II Call
� O You must call the inspecNOr when ready! Date Ready:
1 ce�ify that I am the LICENSED COMRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
,1ob Address (Street, B�-oIx, or R�o'`e No. City � �J Zip Code
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I Section
Power Supplier
Electrical Contredor / Company Name
F �-_AINE HTC. A/C El
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E&00001AA3 7/1l2000
Range Fire No. County�
Phone
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Address
CoMractor License Number
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