P - 82463REQUEST FOR ELECTRICAL INSPECTION '
1 � � � � � � � Minnesota Board of Electricity �
� � �� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� �� °° (651) 642-0800 l"TY/M RS 1-800-627-�e
www.electricity.state.mn.us
Identiry the work covered by this request: �� n`,., r��, � �� �
C�
I ❑ NEW ❑ REMODEL
401 to 800 Ampere � 1
Above S00 Ampere � 4
�UITS I FEEDERS
0 to 200 Ampere � $5
Above 200 Ampere � ;
RM, COMMUNICATION,
�UITS, CIRCUITS OF L
Each Svstem Device or
CONTROL, SIGNALING
50 VOLTS
� $.50
n F
Outdoor Li htin Standard � $1
Traffic Si nai Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transiortner / Power Su I for Si ns I Outline Li htin �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and�or Power Supply up to 500 Amperes, All
Circuiis and Two ins ection Trips Each Dwellin Unft �$6(
Additional tns ection Tri s�$20
Investi ative Fee
Reins ection Fee � $20
TOTAL FEI
(minimum total fee is $20
Each Additional Unft � $25 r0fl "'S°E`"°" "� °"�
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 er Fi
Center Pivot Irri atbn Boom � �" r-
Manufactured Home Park Lots �$25 � here cerMy that � inspec[ed tlie e�edricel i�taNa6on described herein on fhe
Recreational Vehicle Park Sftes �$5 1010"'"
Se rete Bondin Ins 'on � $20
S ial In 'on �$30 er Hour °M'�NBPEC101
S �al Ins ion �$.31 r Mile
_ THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT S
FOR OFRCE UEE ONLY
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18 MONTHS_ _
I certify that I am tl�e �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address � et, Box, or Route No.) w Cily � Zip Code
V,
Sectbn Township Range Fire No. County �
Power Supplier — � � Address
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A�ai�r��(C�nVa orpp$ny4o[,QWn r Perfortning
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Authorized Signature (Contract n or Own r erfoi
EB-00007A-13 7/1/'�N
Phone
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Number I Master Lk�nae
Installadon)
�
�ing Instatlation) Phone
.� �____� '7�3 - �57-5090
BOARD OF ELEC7RICRY COPY INS7RUCT10NS ON BACK � YELLOIN COPY