P - 80439REQUEST FOR ELECTRICAL INSPECTION
�� 0�2 6 3 3 Minnesota Board of Electricity ��
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
< 0 (651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. state, mn. us '� �
Identify the work covered by this request: •
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR �!/�C.� {-/^fi-C'LL'.�—
GENERAL FEES tdoor 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 �$10
Above 800 Am ere �$75 Transfortners over 10 KVA �$20
IRCUITS / FEEDERS ` Transfortner / Power S I for S' r�s / Outline Li h6 �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$70 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 IESS THAN 50 VOLTS Additional Ins ectlon Tri s�$20
Each S stem Device or A aratus �$.50 Investi tive Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$5o Per Unit (minimum total fee is $20
Each Additional Unit (� $25 F017 �NSPECTOfl USE ONLV
OTHER ADDITIONAL FEES F4
Li htin Retrofit �$25 er Fixture �1''v"`�
Center Pivot Irri tion Boom �$40
Manufactured Home Park Lots �$25 I hereby certity that I inspected the elecirical installalion describetl her�n an the dat&s sleted:
Recreational Vehicle Park Sites �$5 HO1�"" 0A7E
S rate Bondin Ins � $20
S' I!n ion �$30 r Hour �'"'�C"0N °"'�
s ia� � ection �$.s, r n� T/� 3_ c�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Request e� Rough-in InspecUon Required? ❑ Yes o Inspection Other Th Rou -In: dy Now � Will Call
You must call the inspector when readyl Date Ready: 1�
1 certity that I am t ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspectiai of ttie elecfical work at:
Job Address (S , Box, or Rou[e No.) City . T�p Code
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Section Township Range Fire No. Counry
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Occ n � � Phon�� � �� � ��
Power Supplier ress
Electri Contractor / Company Name � Contractor License Number Master License Number
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Mailing ddress {Contredor, Company or Owner Performing Installation)
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Authorized Signature (CoMractor, Company or Owner P rming Installation) Phone
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EB-00001A•13 7/1/2000 BOARD OP ELECTRICRY COPY INSTqUC710N3 ON BACK OF YELLOW COPY