P - 79648� REQUEST FOR ELECTRICAL INSPECTION
1 � � � � � � � � � Minnesota Board of Electricity °�`
6:� _� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� �ee �;�. (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us
Identity the work covered by this request: e, f��'� a Ah
rN
❑ NEW REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard �$t
SERVICES / POWER SUPPLIES TraHic 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 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Ins ection Tri s Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri �$20
Each S tem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE 3C'J
3 to t2 units �$5o Per unit (minimum total fee is $20) �
Each Additional Unit �$25 wA ��saECroA �s a+�
OTHER ADDITIONAL FEES /�-��C d�'� ��z"'�,��=
Li htin Reirofd �$.25 er Fixture
Center Pivot Irri aUon Boom (� $40
Manufactured Home Park Lots �$25 I hereby ce' that I inspected the electrical installatlon described herein on the dates slated:
Recreational Vehicle Park Sites � $5 �" �' °"'�
S rate Bondin Ins ection �$20 ���� �
S ial Ins 'on (� $30 r Fbur "W'` "�CfON DA7E
S ecial Ins ection �$.31 AMe � dt
_ THIS INSTALLATION MAY_BE ORDERED DISCONNECTED IF N_ COMPS,F�EQ_WLTHIN_18_�A —_
FOR OFFICE USE ONLY
I IIIIII illli I(III i�ll! Ellll INI! 111N Nl111111 Ilil � �33 �f/�
� 1 Z Z 9 7 O 5 7�E � '7'���
I certi(y that I am the�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elechical work at
Job Address (Street, Box, or�ute NoJ City �� �� Zp�� ��
Section Township � �� Fire No. C nty — ��
�
r �t.
Pow r Supplier Ad ss
�s � '
EI rical Co hactor / Com ny Name
�s ��
Mailing _ ress {Contrac[or, Compa� or dwner erforming Inst.
License
�� �� �
�nature (Contractor, C a or PeAortning Installatlon) Phone
7/1/2000 BOARD OF ELECTRICITY COPY
Number
�J�/�+� T� �
INSTAUCTIONB OM BACK OF YELLOW COPY