P - 77036REQUEST FOR ELECTRICA INSP CTIO G1
1���-F �� 5 4 2 Minnesota Board of Electriciry �Q� —� o�U�l
1821 University Avenue Suite S-128, Saint Paul, Minnesota 551b4
(651) 642-OS00 TTY/MRS 1-800-627-3529 -
www. electrici ry. state. mn. us
IdentiTy the work covered by this request:
❑NEW ❑REMODEL ❑ADDITION PAIR m-�,%� �Cc��
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am re�$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Trensformers over 10 KVA �$20
CIRCUITS / FEEDERS
0 to 200 Am re�$5
Above 200 Am re � $10
ALAFiM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Unils �$50 Per Unit
Each Addftional Unit � $25
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$8(
Additional Inspection Trips � $20
Inves6aative Fee
total fee is $201 J y,
Li htin Retrofit �$25 er Fixture
Center Pivot Irri ation Boom �$40
ManufaCtured Home Pafk LoGS �$25 I hereby cert that I inspected the electrical installafion described herein on the dates stated:
Recrealional Vehicle Park Sites �$5 fl01�'" �"T�
S rate Bondin I ion �$20
S ' I In 'on � $30 r Fbur "K'" "�PE0P0" �� (� 0A1E -��
S'al In 'on �$.31 r Mile ���•j� � ���
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Reque a: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now Will Call
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� �D � You must call the inspector when readyl Date Ready:
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY � OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
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Section Township Range Fire No. County
. 38 �� �r�
� Occupant
� Mailing Address (Contractor
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or Owr�@r PeAortning Installation)
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�ap�or Owner Pg¢Qrtning Installation)
Phone
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nse Number Master License Number
Phone
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3 7/1/2000 � BOARD OF ELECTRICITY COPY INS7RUC7qNS ON BACK OF YELLOW COPY