P - 79897REQUEST FOR ELECTRICAL INSPECTION
�( %Q Minnesota Board of Electricity �`
'1 = 2 9 2� 1 I J ���v 1821 Universiry Avenue Suite S-i28, Saint Paul, Minnesota 55104
�, (651) 642-0800 TTY/MRS t-800-627-3529 ��� ��
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www.electricity.state.mn.us
IdentiTy the work covered by this request:
❑ NEW EMODEL ❑ADDITION ❑ REPAIR � ��� 7 �� �� d �
GENERAL FEES Outd�r Li Min Standard �$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 � Trans(ormers u to 10 KVA (� $10
Above 800 Am re �$75 Transformers over 10 KVA �$20
IRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am re �$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re�$10 Includes the Service and/or Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SI�NALING Circuits and Two Inspection Trips Each Dwelling Unit �$80
CIflCUITS, CIRCUITS OF LESS THAN 50 VOLTS Add'dional Ins ion Tri s�$20
Each S stem Device or A ratus �$.50 Investi ative Fee
ADDITIONS�07HE GENERAL FEES Aeinspection fee �$20
Each Additional Unit � $Z5- � `
OTHER i4DDITIOP
Lighting ReVofA � $25 per Fixture
Center Pivot Irrigation Boom � $4C
Manufac1ured Home Park Lots � $
I herebv certlfv that I
(minimum total fee is $20�)
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the electrical ins[alladon described herein on the dates
S ecial In ion �$30 er Hair """` "�"""" / �c� """
Special Ins�Uon � $.3�r Mde ��° '—�� T"�S '��3
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFlCE USE ONIY
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Req st Date: Rough-in Inspection Required? ❑ Yes No I�pectton Other Than Rough-{n: ❑ Ready Now ilf CaN
�� � G� You must call the inspector when-rBadyl Date Ready:
I certity that I am the�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspeclion of ihe electrical work at
Job Address (Street, Box, or Route No.) City rp C�ode /
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Mailing Address
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E&00001A-13 7/1/2000
Phone
Address
CoMractor License Number
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OF ELEC7HICRY COPY INSTHUCTIONS ON BACK OF YELLOW COPY