P - 81602. REQUEST FOR ELECTRICAL INSPECTION
%% Minnesota Board of EFactricity "
-� - 0 4 9�� 1 1 ��°', 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
/ �� p� (651) 642-0800 TTY/MRS 1-800-627-3529
`/ ��� www.electricity.state.mn.us `' `
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IdentiTy the work covered by this request: f. ��
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❑ NEW REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard �$t
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transfortners u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I tor Si ns / Outiine Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere @$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALtNG Circuits and Two Inspection Trips Each Dwellin Unit �$BO
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S stem Device or A aratus �$.50 Inves6 tive Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units (� $50 Per Unit (minimum total fee is $20)
EaCh Addltlonal Unit �$25 wa i�*a+ use aa�v
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fixture
Center Pivot Irri tion Boom �
Manufactured Home Park Lots i he cerdty ihat I inspected Ne eledrical installation described herein on Me dates ststed:
Flecreational Vehicle Pa�k Sftes � $5 �"'" °�'�
Seuarate Bondina Insoection � $20 �l
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Request Date: Rough-in Inspection Required? ❑ Yes o Inspection O[her Than Rough-In: ❑ Ready Now ill CaN
�' �� You must call the inspeckor when ready! Date Ready:
1 certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe electrical work at
Job Address Street, x o Route No.) Ci � Zip Code� ��
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Section ypyvr�ship% Range Fire No. CouMy
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Occu nt ( �� one � � ' � �^ �
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Power Supp r Address
285
Electrical CoMractor / Co n Conp+py�qr Licenlse Number Master License IVumber
BLAIN� HT a�, 1�1%���L.ECT., IN�_ �,L�—iV
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Mailing Address �r� Performing Installation)
Authorized i ature (C racto mpany or Orner Performin 1 tallation) Pho� �� �� A
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EB-00001 A-13 7/1l2000 BOARD OF ELECTRICRY COPY INSTHUCTIONS ON BACK OF YELLOW COPY