P - 79832REQUEST FOR ELECTRICAL INSPECTION
1�9 2 5 9 O = Minnesota Board of Electriciry
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� ��„�e>e=e (651) 642-0800 TTY/MRS 1-800-627-3529 -�
www. electriciry.state.mn. us
Identiry e ork covered by this request:
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B`f�EMODEL ❑ADDITION ❑REPAIR
GENERAL 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 S00 Am ere �$50 Transformers u to 10 KVA �$10
Above S00 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two In on Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri �$20
Each S stem Device or aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee �$20 __
MULTIFAMILY DWEILINGS PER UNl ��'p'
3 to 12 Units �$50 Per Unit (minimum total fee is
Each Atklitional Unit �$25 FOR INSYECTOH USE 01AY
OTHER ADDITIONAL FEES
Center Pivot I' ation Boom � S40
Manufactur2(1 Home Pefk� �25 I hereby certily that 1 inspecled tlie electrical i�tallation described herein on the dates stated:
S ecial Ins ection � $30 r Fbur '""""""'�" � ��� / � �
SDecial Inspection � $.31 per MNe � `�'
� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF OMPLETED WITHIN 18 MONTHS
' FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes o Inspection Otlier Than Rough-In: dy Now ❑ Wi�l Call
��"40� You must call the inspector when readyl Date Ready:
I certi(y that I am the �CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection ��I'reki�aJ.�or�,at:
Job 9dcJ�ess ($Meet, x, or Route / � � Ciry �� Z�P
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Fire No. � County
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Electri ntr r/ Comp Nam C Mractor License Number Maste ' nse Nu ber
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Mailing Add (Contractor, ny or Owner Performing Insta� n.� ^� `^— _� IA� ��
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A oriz Signature oMractor, C or Owner Performing Installation) Pho e
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E&00001A-13 7/t/2000 BOARD OF ELE PY MSTRUCTIONS ON BACK OF YELLOVY COPY