P - 81734REQUEST FOR ELECTRICAL INSPECTION
1 s O�� r� O Z � Minnesota Board of Electricity `` �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� �Ae°a ,`� (6b1) 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 �L�Q� � �- ��r
GENERAL FEES oor Li htin Standard �$t
SERViCES / POWER SUPPLIES Traific Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am re �$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 Inciudes the Service and/or Power Suppty 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 Additbnal Ins ection Tri s�$20
Each S stem Device or A ratus �$.50 Investi ative Fee
ADOfT10NS TO THE GENERAL FEES Reins ction Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$50 Per Unit (minimum total fee is $20)
Each Additional Unit �$25 F017INSPECTOF USE ONLY
OTHER ADDITIONAL FEES
Li t' Retroffi �$•25 r Fixlure
CeMer Pivot I' ation Boom (� $40
Manufactured Home Park Lots I here cerrlifty that I inspected ttre electrical installa6on des<xbed nerein on tlie dares slared:
Recreadonal Vehide Park Sites "01tl1N °A7E
Se arate Bondin Ins �on � $20
ial In � $30 Hour `N"` "�C101 p,� °A�
S ecial In ion �$.31 r Mile ��� O-��°�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
11111111111i lilll llll1111111�111�Iff Illl i!!I ��,�3, •
�t 1 O 8 6 6 O 1 d� �D��
D te: Rough-in lnspection Required? ❑ Yes o Inspection Other Than R -M. Now � Will GaU
You must call ihe inspector when ready! Date Ready: � �� �
I ceRity that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical wak at
Job Address (Street or Route No.) �� Ciry ��/ ,/�/ z�
V���'
Sec[ion Township � Range Fire No. Counry
8
� !/' �i /.Vl e � � ��Q���/i. Phone �� v ��
Power Supplier Address
Electrical tractor ! Company /� Contractor License Num6er Master License Number
IVt� �GC�t t� i? vc7
Mailing A {Contrador, Company or Owner Pertortning lnstall )
�� G4%/ /t �f ` /1..�
Authorized S' aNre {Contr , Company w r PerEortning Installatian) Phone
. L/'� /Z %��d�
EB-WOOtA-13 711I2000 BOAHD OF ELECTHICITY COPY � Ni87AUCf10N9 0�7 BACK�OF YELLOW COP'