P - 79710REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity —
�� 1��- 5 5 6 �E� `;` i821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
.���„ (651) 642-0800 TTY/MRS 1-800-627-3529
www. electrici ty. state. mn. us
Identify the work covered by this request:
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES 0 door Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nai Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to S00 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am ere (� $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Indudes the Service andlor Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circufts and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additlonal Ins ction Tri s�$20
Each S tem Device or A ratus �$.50 Investi atNe Fee
ADDITIONS TO THE GENERAL FEES Reinsoection Fee �$20
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units (� $50 Per Unit
Each Addi�onal Und � $25
OTHER ADDITIONAL FEES
Li Min Retrofit �$25 r Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites � $5
total fee is
4
linsoected the electricalinstallation described herein
S 'al Ins ion � $.31 A�le / " " - —
�THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF COMPLETED� I 18 MONTHS _�
FOR OFFICE USE ONLY � lla�i^�
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Request Date: Rough-in InspecMion �Required? ❑ Yes , No Inspection Other Than Rough-In: eady Now � Will CaN
'� � You must call the inspector when ready! Date Ready:
I certify that I am the�CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the e�ectrical work at:
Job Address (Sheet, Box, or Route NoJ City ZP �de
�T� / �
Section Township Range Fire No. C nry
OcapaM
Power Supplier
EI 'cal Contractor / Company Name
Mailing Address (Contractor, Comparry
�
A rized Signature (Co ractor, Corr
�
E&00001A-13 7/i/2000
or Owner
or
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BOAND OF ELECTAICRY COPV
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Number I Master
''?Y'� 04 3 0� f I
INSTRUC710N3 ON BACK OF YELLOW COPY