P - 80511� , RE(�UEST FOR ELECTRICAL INSPECTION
1 0 4 8 312 �' Minnesota Board of Electricity
� � a 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 ';
� ', (651) 642-0800 TTY/MRS 1-800-6273529
www.electricity.state.mn.us '' '
identity the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES I POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 io S00 Am ere �$50 Transformers u to 10 KVA �$10
Above S00 Am ere �$75 Transformers over 10 KVA �$20
C RCUITS I 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 andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING CircuRs and Two Inspection Trips Each Dwelli Unit f� $80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addiiional Ins ction Tri s f� $20
Each S stem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins 'on Fee �$20
MULTtFAMILY DWELLINGS PER UNI TOTAL F
3 to 12 Units �$50 Per Unit (minimum tota! fee is $2
EBCh Addltional Uf11f �$25 F°" ir�c'°" "SE °"`Y
OTHER ADDITIONAL FEES
Li h6 Retrofit �$25 r Fature
Center Pivot Irti ation Boom �$40
Ma(1ufaCiured HOrtle Park LotS �$2 I hereby cert' that I i ed the elechical insWlation described herein on ihe detes slated:
Recreational Vehicle Park Sites � A01GX1N ��
Se arate Bondin In 'on � $20
S ecial Ins ection �$30 r Hour FlN4L INSPEGTON ��
S ial Ins eclion �$.31 r Mile <� 2��
_ THIS�SIALLATION MAY BE ORDERED DIS�ONNE�TEQ_1F �107 �Q�1AP�ETFn wrrHiN1$ MONTHS
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspectian Required? ❑ Yes o Inspec[ion Other Than Rough-In: ❑ Ready Now Will Call
� o u call the inspector when ready! Date Ready:
I certify that I am the ❑ LIC TOR ❑ COMPAN an equest inspection of the electrical work at:
Job Address (Street, Box, or Route No.) City � � ZP ��
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Section Township Range Fire County
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Power Sup 'er Address
Electrical Contrecror / Company Name Contr�yctor License Number Master License Number
Mailing Address (Convactor, Company or Owne�lfojrnin9�,sta�ion)�., � �� AI ^,
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Authori t ctor, Compa erfo ' nstallatian) Phone
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