P - 77580REQUEST FOR ELECTRICAL INSPECTION
% Minnesota Board of Electricity �"�
1� 3 4 7�� O 1 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� (651) 642-0800 T'fY/MRS 1-800-627- 29 =
www.electricity.state.mn.us �(���b����
Identity the work covered by this request:
❑NEW EMODEL ❑ADDITION ❑REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
Traffic S' nal Standard � $5
0 ro 400 Am re �$25 S lemental Fee �$20
401 to 800 Am re �$50 Transtormers u to 10 KVA �$10
Above 800 Am re �$75 Trans(ormers 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 re �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COM�IUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addftional Ins ection Tri s�$20
Each S stem Device or ratus �$.50 Investi ative Fee '
ADDITIONS TO THE GENERAL FEES Reins ion Fee �$20 ^
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE
3 to �2 units �$5o Per unft (minimum total fee is $20)
Each Additional Unit � $25 fOR "�"`�TOR "� °NLV
OTHER ADDITIONAL FEES �' ,$ G�R'f�. °�'�� °� �K 4 � Fs � ���t ����. S
Li hdn RetroTd �$25 r Fixture �� Su ����'14_ Gf avu�.I
Center PNot Irti ation Boom �$40
MenufaCtu�ed Home P2rk LOtS �$25 I hereby ce�ify tl�at I inspected the electrical installaban described herein on the dates stated:
Recreational Vehicle Park Sites �$5 R01GH "'
S rate Bondin Ins ion �$20
S ial Ins ion �$30 r Hour Fl�`""""�'�"0N
S ial Ins 'on �$.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspechon Required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now �II Call I
�� D� You must call the inspector when ready! Date Ready: �' Z 1[� —� S
I certity that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job A� r� (Street, Box, or �� No.) � � City� t Zip Code
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Occupant P one
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Power Supptier ` Addr4ss `
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Electrical Co�tractor / Company Name Con ractor License Number Master License Number
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Mailing Address (Contrador, Company or Owner Perfortning Installation)
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Authorized Si ature (Co r ctor, Com or Ow r g Installation) one
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EB-OOOOtA-13 7/t/2000 BOARD OF ELECTFiICITY COPY INSTAUCTIONS ON BACK OF YE�LOW COPY