P - 79705' ` Y REGIUEST FOR ELECTRICAL INSPECTION
1 � � � � � � 7 � , Minnesota Board of Electricity "�
�� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�� �» (651) 642-OS00 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us "8°e'
Identify the wark covered by this request: ��G'� —�� )�" �C%1
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❑NEW ❑REMODEL ❑ADDITION REPAIR � � �, �� ' ��
GENERAL FEE Outdoor Li htin Standard �$1
SERVICES I POWER SUPPLIES Traific Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere C� $50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspectron Trips Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20
Each Svstem Device or Aooaratus �$.50 Investlgative Fee
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit �$25 FON INSPECTOR USE (
OTHER ADDITIONAL FEES
Liahtina Retrofit � $.25 cer Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots �$25 I hereby ce' tliat I inspected the eledrical i�tallation described herein on tlie date.s
Recreational Vehicle Park Sdes � $5 "01G1 "' °
Seoarate Bondina Insoection � $20
� � Special Inspection �$ 31 per Mile � � ✓ �'�
__ _THIS INSTALLATION MAY BE ORDERED_DISCONNECTED IF NOT C0IAPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Request bate� Rough-in Inspection Required? ❑ Yes � No Inspection Other Than Rough-ln: Ready Now ❑�II Call
' I � b You must call the inspector when ready! Date Ready:
I ceRify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (St et, Box, or Route No.) ��� City � Ztp
I
ection ownship, Range Fire o. Couniy _�, �_ ,
Phone
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Address
x/ Compa� Narr�� _� �� � I G�trac^ L cennse
ompany or
or
t���c��c� � ���-dyy ���u i
3 7/1/2000 BOARD OF ELECTHICRY COPY INS7RUC710NS ON BACK OF YELLOW COPY