P - 80444, REQUEST FOR ELECTRICAL INSPECTION
1 10 8 5 6 O 9 Minnesota Board of Electricity —
� � °T ��' 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
����``�? (851) 642-0800 TTY/MRS 1-500-627-3529
www.electri�city.state.mn.us `'�'
identlfy the work covered by this request: �, 1 G�� /1 �_3�3�0 ,
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❑NEW ❑REMODEL ❑ADDITION REPAIR �°
GENERAL FE Outdoor Li htln Sta dard �$1
SERVICES 1 POWER SUPPLIES Traffic Si nai Standard �$5
0 to 400 Am ere (� $25 Su lemental �ee C� $20
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transtormer / Power Su I for S' ns / Outline L' htirt �$5
0 to 200 Am re �$5 ,�-- ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service and/or 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 ection Trips �$20
Each S stem Device or aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE O
3 to 12 Units �$50 Per Unit (minimum total fee is $20)
EaCh AddiGonal Unit �$25 FOH �N57ECTOR USE ONLV
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fxture
Center Pivot I' ation Boom �$40
MafllAaCtUred Home Pafk LotS � I hereb certify that I inspecled the electrical instailatbn described herein on the dates st�ed:
Recreational Vehicle Park Sites � $5 �"'" °ATE
arate Bondin Ins ion � $20
S ial In 'on �$30 er Hour """` "'�`'"0N ? �"�
S ial Ins ecdon � $.31 r Mile � / ' Z ; � � �
THIS lNSTALLATION MAY BE ORDERED DISCONNECTED IF NOT OMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONIY
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Request Da : Rough-in Inapection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now 0 Will Ca�l �
� D You must call the inspector when ready! Date Ready:
I certify that i am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby requesl inspection of tl�e electrical work at
Job Adclress (Str x, or Route No.) City Zp Code
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Section Township Range Fire o. County
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Occu ant �� Phone —
Power Supplier Address
EI 'cal ConVador / Company N e CoMractor License Number Mester License Number
M,ai�ing Add s(Con or, pan or Owner ertormi g Installation)
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Authorized Signature (C Ilation) Phone _ �
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EB-00001A-13 7/7l2000 � BOAHD OF ELECTAICRY COPY INSTRUCTWNS ON BACK OF YELLOW COPY