P - 78297REQUEST FOR ELECTRICAL INSPECTION
-`/� 7 Minnesota°Board of�Electricity
�~ �`t I- 3 5 7 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TlY/MRS 1-800-627-3529
www.electricity.state.mn.us
I ❑ Neuv
y this request:
❑ADDITION ❑REPAIR
GENERAL FEES
401 to 800 Am ere �$SfY �
Above 800 Am re � $75
CIRCUITS / FEEDERS
0 to 200 Am ere �
Above 200 Am re � $1
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Apparatus �$.50
3 to 12 Units �$50 Per Unit
Each AddiUonal Unit � $25
OTHER ADDITIOP
Lighting Retrofit � $25 per Fixture
Center Pivot Irrigation Boom � $4C
Manufactured Home Park Lots � $
Recreational Vehide Park Sites �
Separate Bonding Inspection � $21
Special Inspection � $30 per Hour
Sceaal Insoection � $.31 cer Mile
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Outdoor Li htin Standard � $1 / � —
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Oudine Li h6n �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Suppty up to 500 Amperes, All
Circuits and Two Inspectbn Trips Each Dwellin Unit �$8f
Additional Inspection Trips � $20
Investlaative Fee
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iereb ceAify that I ins ected the electrical ii
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115 INS7ALLATION MAY BE ORDERED D�SCONNECTED IF NOT COMPLETED W
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Request D te: Rough-in Inspection Required? �E Yes ❑ No Inspeclion Otlier Than Rough-In: ❑ Ready Now Will Call
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You must call the inspector when ready! Date Ready:
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY �j OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) City Zp Code
115' ISJ(,AN '�r�KW'% '� �E, , �FQ.� OL�`� 5 S 4 3Z
Section Township Range Fire No. County
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OccuPaM Phone � f S � � / 1 � � S / �
pA-�--� t�oN�-a � �� 3 � G�� �o �
Power Supplier Address
E �L� L i�(-.� o��'-1 �!t/.
Electrical Contractor / Company Name Contractor License Number Master License Number
OW 1� � (Z
Mailing Address tractor, Co� y or Owner Perfortning Installation)
Authoriz gnature (Contractor, Company o Owner erforming Installation) Phone
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EB-00001A-13 7/1/2000 � BOAHD OF ELECTRICRY COPY INS7AUCTION3 ON BACK OF YELLOW COPY