P - 79850REQUEST FOR ELECTRICAL INSPECTION
�° Minnesota Board of Electricity "``�
.� � 2$ q. � H 7 6 �° 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�- �r �°� (651) 642-0800 TTYIMRS 1-800-627-3529
www.electricity.state.mn.us
Identity the work covered by this request:
EW ❑ REMOOEL ❑ ADDITION ❑ REPAIR G/� /�
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 S00 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am efe �$75 Transfortners over 1� KVA �$2�
RCUITS / FEEDERS Transformer / Power Su for Si ns / Outline Li hti �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service andlor Power Supply up ro 500 Amperes, All
AIARM, COMMUNICATION, REMOTE CONTAOL, SIGNAIING Circuits and Two 1 ' n Trips Each Dwelli Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS AddiUonal Ins ion Tri s�$20
Each S stem Device or aratus �$.50 lnvesti ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY �WELIINGS PER UNI TOTAL FEE
3 to �2 Units �$5o Per Unit (minimum total fee is $20)
Each Additlonal Ufllt � $25 f0"'�CTO" `� °NLV
OTHER ADDITIONAL FEES
L' hG Relrofit �$25 r Fixture
Center Pivot Irri ation Boom �$40
Manufactwed Home Park Lots �$25 1 hereby certity ihat 1 inspecled ihe electrical instaltation described herein on tlie dat� slated:
Recreational Vehicle Park Sites �$5 p01�"'" °"'�
Se arate Bondin Ins ion �$20
S ecial Ins ection �$30 er Hour t """""S"ECn°" °"�
S ia{ !ns ion �$.31 Mile `T /o— oi
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
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FOR OFFICE USE ONLY
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Request ate: Rough-in InspecUon Required? ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now ill Call
� .� You must call the inspector when readyl Date Ready:
I certity thai I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address ( heet, Sox, or Route No.j City Zip Code
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Section Township Range Fire No. Coun
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Occupant � ������� Phone
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Power Supplier Address
E cal CoMrad / Company N� CoMractor License Number Master License Number
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Mailing Address (Co ctor, Company or r Performing Ins on)
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Authoriz Signature Mractor, C r W��fer Perfortning Installation) Phone
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EB-00001A-13 7/1/2000 BOARD OF ELE ICRY COPY WSTAUCTIONS ON BACK OF YELLOW COPY