P - 78339REQUEST FOR ELECTRICAL INSPECTION
1� 3 47 ���-F 8 ° a° Minnesota Board of Electriciry
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
` �er ;�. (651) 642-0800 TTY/MRS 1-800-627-3529 =
www.electricity.state.mn.us ��� ��
Identify the work covered by this request:
❑NEW EMODEL ❑ADDITION ❑REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am re�$25
401 ro 800 Am ere �$50
Above 800 Am re � $75
CIRCUITS / FEEDERS
0 to 200 Amoere � �.5
npere � $t0
JICATION, REMOTE CO
IITS OF LESS THAN 50
Device or Apparatus �
DDITIONS TO THE GE�
IELLINGS (PER UNIn
� $50 Per Unit
31 Unit � $25
�fA � $25 per Fixture
Irrigation Boom (� $4�
I Home Park Lots � $
Vehide Park Sites � ;
Outdoor
Su lemental Fee � $20 '
Transformers u to 10 KVA �$10
Transfortners over 10 KVA � $20
Transfortner / Power Su for Si ns / Outline Li htin �
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelli Unit �$8(
Additional Inspection Trips � $20
Investiaative Fee
V (minimum total fee is $20) 'y
WH INSPECTOIi USE ON�Y � `
FEES � ��! `'
/. 9�� ���� /y�-"�'�C!'
he e�y c� that I inspected tl�e elecVical in�sllation described herein on tlre daks stated:
5 ecial Ins ection �$30 r Hour Fl""� �"��+ ��
S ial In ion �$.31 r Mile ,
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF OT COMPLETED WITHI 18 ONTHS
_ -- — -_ _ . _ - -- _
FOR OFFICE UEE ONLY �
� ���
Illlllllllllllllllllilllllllilllllllllllllllllllil - �,
�E 1 3 4 7 3 4 8 3�E � �
Request Date: Rough-in Inspectlon Required7 ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now Q Will Call
You must call the inspecta when ready! Date Ready: � �
1 cert'rfy that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elechical work at:
Job Address (Street, Box, or Route No.) City Zip Code
,%S80 A/de.rt k,� j�-�d� -' SS�/.3 Z
Section Township Range Fire No. Counry
Occupant Phone
D��r;oc Yanc�
Power Supplier r
Electrical CoMractor / Company Name CoMractor License Number Master License Number
Mailing Address (Conhactor, Company or Owner Pertorming Installation)
Authorized Signature (Contra or, Com any or Owner Performing Installation) P�^edry _��_23d'3 �w�
A�vto�� � �'
EB•00001A•13 7/7/2000 � BOAHD OF ELECTRICITY COW INSTRUC770NS ON BA OF VELLONf CAPY