P - 79618. REQUEST FOR ELECTRICAL INSPECTION
.1- 2 4 8��� 4 � 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.mn.us " '
Identity the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR V(/ ��' �Z�u�X-��
GENERAL FEES 0 or Li htin Standard �$t
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere f� $25 Su lemental Fee �$20
401 to S00 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
IRCUITS / FEEDERS � Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re (� $10 Includes the Service and�or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Tri s Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Insoection Trios �$20
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL F
.TIFAMILY DWELLINGS (PER UNI�
3 to 12 Units �$50 Per Unit
Each Additionai Unit � $25
OTHER ADDITIONAL FEES
Lic�hti� Retrofit � $25 per Fixture
Center Pivot Irtigation Boom � $40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites � $5 ,
Separate Bonding Inspection � $20 =
Soecial Insoection � S30 oer Hour
FOR INSPECTOfl USE ONLY
Fee
total fee is
on the dates sfated:
.° �"T�_.�.� I
TNIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTNS
FOR OFFICE USE ONIY
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Request a� Rough-in Inspection Required? ❑ Yes Inspection Other T a Roug -In: ady Now 0�II Call
You must call the inspector when readyl Date Ready:
I certify that I am the�CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and here requ st inspection of the electrical work at:
�on nddress s►� ►( D�i �tneA o.�� �� . c�ry �(�' �.i J\ Z�P���
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� Electrical Coptcactor / Company Name
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E&00001A-13 7/1/2000
CoMractor License Number
L�- �� li�X
or Owaer PeAomting t stallation)
W✓ � �� IV�
pany or Owner Perfo ing Installation) I
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BOAHD OF ELECTRICRY COPY �
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INSTHUC710NS ON BACK OF YELLOW COPY