P - 80155REQUEST FOR ELECTRICAL INSPECTION
�� � � � � � Minnesota Board of Electricity
� � v� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
��_ (651) 842-OS00 TTY/MRS 1-800-827-3529 � ���
t. . ;.....
www. e lectnctty. state. mn. us
IdentiTy the work covered by this request:
❑ NEW REMODEL ❑ ADDITION ❑ REPAIR � ✓� � 1 6 l '� � `-'�
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$70
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CUITS I FEEDERS Transformer I Power Su I for Si ns / Outline Li hfin �$5
0 to 200 Am re�$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service and/or Power Supply 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 Additional Ins ion Tri s�$20
Each S tem Device or A aratus �$.50 Investi tive Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fce �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units � S50 Per Unit (minimum total fee is $20)
Li htin Retrofit �$.25 r Fixture
Center Pivot frri ation Boom �$40 •
Manufactured Home Park Lots �$25 I hereby certiy that I ins the electrical installation described herei� «i the dates statad:
Recreational Vehicle Park Sites � $5 "�" �" ��
Se rate Bondin Ins 'on � $20
S ecial Ins ection �$30 r Hour """L'ru°EC"°" �^T�
S ecial Ins ection �$.37 r Mile �~�
THIS INSTALLATION MAY BE ORDERED DiSCONNECTED IF NO PLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Reque�t.pa��� �� Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now Vril Call
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Q You must call the inspector when ready! Date Ready:
( certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNEH and hereby requesi inspect+on of the elecirica! work aF.
Job Address (Street, , or Route No.) City Zip Code
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Sectioh Township Range Fire No. C nry
°1�_` ��°fN1i�a7�I�i"�LECT., tr�C,
i356? CENTr�AL AVE. N.E.
Mailing Address , o � Performirn
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Authorized ' re (C act m er Perfa
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EB-OOOOtA-13 7/1@000
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OF ELEC7AICITY COPY . INSTFIUC710NS ON BACK OF YELLOW COPY