P - 82019REQUEST FOR ELECTRICAL INSPECTION
� > Minnesota Board of Electricity �' °
1�� 1- � v- 6 5 7� �821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OS00 TTYJMRS 1-800-6273529
www.electricity.sta . n:us '' '
Identify the work covered by this request: _
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR ' � � � �
0 to 400 A
401 to 800
Above 800
�UITS 1 FE
0 to 200 A
Above 200
RM, COMN
JUITS, CIR
Each Svste
npere � $50
ipere � $75
ERS
are '� $5
ipere � $10
IICATION, REMOTE CONTROL, SIGI
ITS OF LESS THAN 50 VOLTS
Device or Apparatus � $.50
)DITIONS TO THE GENERAL FEES
Each Addftional Unit � $25
OTHER ADDITIONAL
Lighting Retrofd � $25 per Fixture
Center Pivot Irrigation Boom � $40
Manufactured Home Park Lots � $25
RecreaHonal Vehicle Park Sites � $5
Seoarate Bondi�a Insoection � $20
Outdoor Li htin Standard � $1
Tratfic Si nal Standard � $5
Su iemental Fee � $20
Transformers u to 10 KVA C� $10
Transformers over 10 KVA � $20
Transformer / Power Su for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, AII
Circuits and Two Ins ection Trips Each DweHi Unit �$8(
Additional In ion T' � $20
Invesf ative Fee
Reins�ection Fee � $20
I herebv certilv tl�at I
desaibed herein
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FOR OFRCE llBE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: Ready Now w�l Call
� " �/ You must call the inspector when readyl Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the eleciiical work at:
Job Address (Street, Box, or Route N) City �,�> Zp Code
3SG �C'2.e� �
Section Township Range Fre 4JO. CouMy „ ,
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D�P�NDAB�'
dd
C�on Rapids,
�-
EB-UWOIA•13
Phone
Address
I�. I��t Contractor License Number Master Lkense
�pmer Pertormi� Installation)
3
er ortning Installation) Phone
BOAAD OF ELECTRICITY COPY
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