P - 77646REQUEST FOR ELECTRICAL INSPECTION
1 3 4 7 5 0 3 Minnesota Board of Electricity �.
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� (651) 642-0800 TTY/MRS 1-800-627-3529 =
www.electricity.state.mn.us aoO�'— �� fl�
Idemi(y the work covered by this request:
EW ❑ REMODEL ❑ADDITION ❑ REPAIR �Lt�'-�.e:xL� �jd �-
GENERAL FEES Outdoor Li htin Standard � 1
SER ES / POWER SUPPLIES Traffic Si nal Standard �$5 •
0 to 400 Am re �$25 „�' Su lemental Fee �$20
401 to B00 Am re�$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am re 8$5 ONE & TWO FAMILY DWELLIN�S, EACH UNIT
Above 200 A re �$10 Includes the Service and/w Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and TwoJnsp'e`ction Trips Each Dwellinp Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A ratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 UniGs �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Retrofit f� $25 per Fixture
Pivot Irrigation Boom � $40
�tured Home Park Lots � $25
ional Vehide Park Sites � S5
Hour
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IS INSTALLATION MAY BE ORDERED DISCONNECTI
total fee is
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the electricalinsfallatiai described herein on the dates stated:
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COMPLETED WITHIN 18 MONTHS
I ceRify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
1501 f..�C`s�o` r� F�.D�.� ,S-�-r�.3 Z
Section Townshi Range Fire No. County
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Occupant Phone
Power Supplier �� Address ��� _ �� �
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Electrical Contrador / Company Name Contractor License Number Master License Number
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Mailing Address (Contractor, Company or Owner P ing Installation)
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Authorized Signature (Contractor, Comp r Performing InstallaUon) Phone
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EB-00001A-13 7/1/2000 BOApD OF ELECTRICfTY COPV INSTRUCTIONS ON BACK OF YELLOW COPY