P - 81728REQUEST FOR ELECTRICAL INSPECTION
(��'' Minnesota Board of Electricity
�, !�` V 2 O� g O 9 " 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
' a�°°�� (651) 642-0800 TTY/MRS 1-80�-627-3529
www.electricity.state.mn.us b �
Identify the work covered by this request: 1����� �M> `G��, ,.,^ ��QR� �� 1U \ LQ,
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❑NEW �iEMODEL ❑ADDITION ❑REPAIR ('ryQ D ( R..I��Q.�.Q . : (Y��' 1lIXX VIQ.i� � '�1� .
0 to 400 Am ere �$25 O
401 to 800 Am ere �$50
Above 800 Am ere � $75
IRCUITS ( FEEDERS
0 to 200 Am ere �$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTFOL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL F
Center Pivot
ManuFactured
Su demental Fee � $20
Transformers u to 10 KVA �$10
Transtormers over 10 KVA C� $20
Transformer / Power Su for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 AmQeres, All
Circuits and Two Inspection Trips Each Dwellin Unit �$8(
Additional Ins ection Tri s�$20
Investi ative Fee
Reir�soection Fee � $20
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ER ADDITIONAL FEES �
:5 er Fi�RUfe /��'✓.C+�
Boom � $40 P,(,� —
ark LotS �$25 I herebvi certiN that I insoected the electrir�insle
total fee is $20) ��
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n ascribed herein o� tha dates sYated:
wre .
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S ecial Ins ec6on �$30 er Hour
S 'al In�ecHon � $.31 per Mile _ '� � � '� II
THIS INSTALLATION AAAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 8 MONTH
— - - FOR OFFICE USE WdLY
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Request Date: Rough-in Inspection Required? es ❑ No lnspection Other Than Rough-In: ❑ Ready Now WI�� cal�
� f ��! You must Call the inspector whe� ready! Date Ready: ,
I certify that I am the �UCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby est inspection of the electrical work at:
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Job Address (Sheet, Box, or Route No.) •, n _ GG � I 1 1 J I
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OccupeM I Phone
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ig ature (Contractor, CompanY or uwner rerronrn�y ���>�M������
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� BOARD OF ELECTIi1CRY COPY
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