P - 78334REQUEST FOR ELECTRICAL INSPECTION
1�4 7 3 9 6 Minnesota Board of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electrici ty. state. mn. us
Identify the work covered by this request: �
❑ NEW MODEL ❑ ADDITION ❑ REPAIR C} C/ G� L--
GENERAL FEES Outdoor Li htin Standard �$1
SE ICES / POWER SUPPLIES Tratfic Si nal Standard �$5
0 to 400 Am re �$25 Su emental Fee (� $20
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su for Si ns / Outline Li htin �$5
0 to 200 Am re ONE 8 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 Addftional Ins ion Tri s�$20
Each S tem Device or ratus �$.50 Investi tive Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to �2 Units (� $5o Per unit (minimum total fee is $20)
Each AddRional Unit � $25 F0f1 "� °NL"
OTHER A S ' �
Li Min Retrofit � $25 r
Center Pivot Irri tion Boom �$40
ManufaCtu�2d Home Paik Lots �, $25 I hereby ce' that I inspected the electrical inslallation described herein on ihe dates stated:
Recreational Vehicle Park Sites �$5 P01GX1N °"'�
S rate Bondin I ' n � $20 '� � —� _ a <
S 'al Ins 'on ��30 r Hour Fl"""'u"ECr'°" � / o=�
S'al In ' n�$.31 r Mile 6
THIS INSTALLATION MAY BE ORDERED DISCONNECTED CONIPLETED WITHIN 1 MONTHS
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ill Call
� z� You must call the inspector when rea . Date Ready:
I certi(y that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY OWNER and hereby request inspection of the electrical work at:
Jab Address (Street, Box, or Route NoJ City Zp Code
7 � �-' � ' i � ss 3
Section Township Range Fire No. County
R I�s
ss (Contrador, Company o�ner Perfortning Installation)
�ature ontrad�ompan� ner orming Installation)
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7/1/2000 BOARD OF ELECTRICRY COPY
3 �- 7 .- Z f�
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Master License Number
Phone
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INSTRUCTIONS ON BACK OF YELLOW COPY