P - 79813. REQUEST FOR ELECTRICAL INSPECTION
7 �,; Minnesota Board of Electricity "�
��� 1 O- 6 5 9 � F 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
��� � (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us
Identi rk covered by this request: G�" ' /����`�"`
REMODEL ❑ADDITION ❑REPAIR Q
GENERAL FEES Outdoor 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 Transtortners over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am re �$5 ONE & 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 Circufts and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S stem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins tlon Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$50 Per Unit (minimum total fee is $20) �
Each Additional Unit (� $25 F011 INSPECTOR USE ONLv
OTHER ADDITIONAL FEES
Li htin Retrofd �$25 r Fi�Rure
Center Pivot Irri ation Boom �$40
ManufaCtur2d Home Palk LotS �$25 ! hereby ' that I inspected the eledrical installation desixibed herein on the dates stated:
Recreational Vehide Park Sites �$5 fl01GH1N DA1E
Se rete Bondin Ins ection �$20
S ial Ins �on �$30 er Hour Fl""""��10N °�'�
S ial In ion �$.31 r Mile � Z`s'' �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE U8E ONLY
I Illt�t iilli It�li IIIII �IIII li�ll IN�I lilll llfl lill ����� �
3E 1 3? O 6 5 9 3 iE � a�'s�
I ce�ity that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job ress (Street, x, or Ro o.) Zi C
!'�-• /�!�'/��� PJJ�-�i�v��
Range
vccupant � � � 12 �
Power Supplier qdd �� ����
Electrical a or / Company Na Contractor License
�'�77 �' �� � � /'��n .
BOAND OF ELECTRICITY COPY �
3=-
,
�,
�
L
��
�ONS ON BACK O YELLOW COPY