P - 78695REQUEST FOR ELECTRICAL INSPECTION
1' 2 9 5 5 4 1 Minnesota Board of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
* (651) 642-0800 T'fY/MRS 1-800-627-3529 � _
www. electricity. state. mn. us
IdentiTy the work covered by this request: /-�,, �
❑ NEW EMODEL ❑ ADDITION p REPAIR `�� �� N j�� `' i
GENERAL FEES Outdoor Li hfin Standard �$1
SERVICES / POWER SUPPLIES Traflic Si nal Standard �$5
0 to 400 Am re�$yE' ' Su lemental Fee �$20
401 to 800 Am re�$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transfortner / Power Su I for Si ns / OuUine Li htin �$5
0 to 200 Am re � ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service ar�dlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins 'on Tri �$20
Each S em Device or ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$5o Per Unit (minimum total fee is $20)
Each Additional Unit � $25 w"'"�`�0R "� °NLV ^ • f- /1��
OTHER ADDITIONAL FEES �- ( �rw�'"1 ��R`�' Z�
Li htin Retrofit �$25 r Fixture ?_�ja`-f �t GF��
Center Pivot 1 ' ation Boom � $40 � _ � „�J � . �
Manufactured Home Park Lots �$25 I hereby ce ' lFat I inspected ihe elechical installaGon desaibed herein on Me �tes stated:
RecreaGonal Vehicle Park Sites � $5 �"" �'�
Se rate Bondi In ion �$20
S ial Ins "on �$30 r Hour """�"E`'"01 ' °Ah
S ial Ins ection �$.31 er Mile �^�—�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED COMPLETED WITHIN 18 MONTHS
FOR OFF'ICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No InspecUon Other Than Rough-In: ❑ Ready Now Will Call
�f�'��j You must call the inspector xihen readyl Date Ready: �
I certity ihat I am the [� LICENSED CONTRACTOR �� COMPANY ❑ OWNER and hereby request inspeclion of the electrical work at:
Job Address (Street, Box, or Route No.) Ciry �' rp Code
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Section Township Range Fire No. CouMy
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OccupaM Phone
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P er Supplier / Address
EI 'cal CoMractor / Company N CoMractor License Number Mester License Number
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Mailing Address ( ractor, pan or Owne PeAorming InsTallffia
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Aut Signature (Co C�ny or Owner Performing Installation) Phone
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EB-00001A-13 1 BOARD OF ELECTFi1Cf1Y COPY INBTAUCTIONB ON BACK OF YELLOW COPY