P - 76539� REQUEST FOR ELECTRICAL INSPECTION
1 3 4 7 4 8 � Minnesota Board of Electriciry
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 T'fY/MRS 1-800-627-3529 =
www. electri ci ty. state. mn. us
Identity the work covered by this request: ��`
❑ NEW +E�FtEMODEL ❑ADDITION ❑ REPAIR �2J'�
GENERAL FEES Outdoor Li htin Slandard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA (� $10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS I FEEDERS Transformer / Pawer Su I for Si ns / Outline Li Min �$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 Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion 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 UNI TOTAL FEE
3 to 12 Units � S5o Per Unit (minimum total fee is $20) �
OTHER ADDITIONAL FEES 6"7 G+y,1 I� �� c.5
' hti Retroffi � $25 r Fixture � � ` � �
Center Pivot I' ation Boom �$40 �' y�y✓/ ��„Q 1 ��' —�6•uo
ManUfaCtUr2d Home Palk LOtS �$25 I hereb certify that I i s'ected the elecirical installatlon described herein on the dates sqted:
Recreational Vehicle Park Sites � $5 "01GH1N " °"'�
S rate Bondi In � $20 � — -�-�+ `�
S' In ' n�$30 r Hour °"'�
S ial In ' n�$.31 r Mile 4"� �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED MPLETED WITHIN 18 MONTHS
FOR OFFlCE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-I�: ❑ Ready Now 0 Will Call
�"[i ��� You must call the inspector when ready! Date Ready:
I ceAify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY �OWNER and hereby request inspection of the electrical work at:
EB-00001A-13 �/1/2000 BOAR� OF ELECTIiICT/ COPY INSTRUCTIONS ON BACK OF YELLOW COPY