P - 78304RE(�UEST FOR ELECTRICAL INSPECTION
/� % Minnesota Board of Electricity b �°�°
1��`t 1- 3 51 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55{0� S
(651) 642-0800 TTY/MRS 1-800-627-3529 �
" www.electricity.state.mn.us � •
Identify the wark covered by this request
❑ NEW ❑ REMODEL,��7IDDITION ❑ REPAIR �Q I � IZ �"7 <^ /� ( �R�— `
GENERAL FEES r Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard f� $5
0 to 400 Am re �$25 Su Iementai 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 Transformer / Power Su for Si ns / Outline Li htin �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere (� $10 Includes the Service andlor Power Suppiy up to 500 Amperes, All
A RM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Ins ion Trips Each Dwellin Unit �$80
CIACUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional I ion Tri s�$20
Each S tem Device or ratus �$.50 Inves6 tive Fee
ADDITIONS TO THE GENERAL FEES Reins sction Fee �$20 'C3
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units � S5o Per Unit (minimum total fee is $20)
Each Additional Unit (� $25 F°R i"S°E°'°" �s� °"�� ,,,,� ,�
OTHER ADDITIONAL FEES
Li htin Retroffi �$25 r Fixture Q O���
Center Pivot Irri atbn Boom �$40 �J
ManufaCtu�ed HOflle Park LotS �$25 I hereby ce' that I inspected Ne electrical installation described herein on the dates stated:
Recreational Vehicle Park Sites � $5 /01GX "' ��//� �' �/ °ATE 3
ae�rofo w,�ni�� ���nnMiM, e P�n l/ �l Q)
� $30 oer Hour
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspedion Other Than Rough-In: ❑ Ready Now ❑ Will Call
You must call the inspeclor when ready! Date Ready:
I certiiy that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY OWNER and hereby request inspection of the electrical work at:
Job Address (SUeet, Box, or Route No.) Ciiy Zip Code
ra�% 3 ��� ,n l,-�..�.` � �- �.c� �. :2 (
Section Township Range Fire No. unry
OccuparH Phone
i� r�;�.,,� �, c�,� %l�3-` �'71,�j(��t"�
Power Supplier Address
305Sf�
Mailing Address (Contrador, Company or Owner Perfortning Installation)
Authoriz ' nature.(Contractor, Com or erforming Installation) Phone
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EB-00001A-13 7/1/2000 BOARD OF ELECTRICfTY COPY INSTFIUCTIONS ON BACK OF YELLOW COPY