P - 81997REQUEST FOR ELECTRICAL INSPECTION
1'� 13 7_ I 5 p Minnesota Board of Electricity -
� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
, �� (651) 642-0800 TTY/MRS 1-800-627-3529
�°
www.electricity.state.mr� us
Identiiy the work covered by this request: �
EW ❑ REMODEL ❑ ADDITION ❑ REPAIR ��
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to A00 Am ere �$25 Su lemental Fee �$20
401 to S00 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transiormers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li Gn �$5
0 to 200 Am ere �$5 ONE & 7W0 FAMILY DWELLINGS, EACH UNIT
Above 200 Am re 8$t0 Inciudes the Service and/or Power Suppiy up to 500 Amperes, All
ALARM, COMMUNICATION, REMO7E CONTROI, SIGNALING Circuits and Two Inspection Trips Each Dweliing Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri �$20
Each S stem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee (� $20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$50 Per UnR (minimum total fee is $20) Oj
Each Additional UnR �$25 Po"'"�"�0" "� 0N19
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fixture
Center Pivot Irri ation Boom �$40
PAanufaCtured HOme PBrk Lots �$25 I her certify that I inspected tl� electrical installation desaibed herein an tlie detes steted:
Recreational Vehicle Park Sites � $5 �"""'" °'"�
Se rate Bondin Ins 'on � $20 «
Soecial Insoection � $30 oer Hour "'�"0N /""` � °ATE
FOR OFfICE USE ONI.Y
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Raugh-In: ❑ Ready Now � NliN Cell
! 'OI You must call the inspector when readyl Date Ready:
I cartiSy that I am the ❑ LICEPISED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (SVeet, Box, or Route �� Ciry /� Zip �� �/�
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Sectio Township Range Fire No. County
Occupant y� Q/ �� � � Phone ��� `_ �/��
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Power Sup lier� � Add2ss '� R _ , /��e�C�� _ _ l /�
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Electri Contractor / Company Name /^� n CoMractor License Number Master License Number �
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Maili Address ( ontractor, ompeny or Owner Pe ortning InstaAatio �i�% "� /����
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Authorized ignatu�e Contr or or Ownar Performing Instalation) Phone
- (P3 -7�53-��
E&OOOp1A-13 7J1J2000 BOARD OF ELECTAICRY COPY INSTHUCTIONS ON BACK OF YELLOW COPY