P - 81947REQUEST FOR ELECTRICAL INSPECTION
1 1� 7 3 01 �" Minnesota Board of Electricity
�, � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
w �as (651) 642-0800 TTY/MRS 1-800-6273529
. www.electricity.state.mn.us
Identity the work cavered by this request; /
❑ NEW ❑ REMODEL ❑ ADDiTfON ❑ REPAIR l�
GENERAL FEES Outdoor Lighting Sta dard �$t
0 to 400 Ampere � $25
401 to 800 Ampere (� $50
Above B00 Ampere � $75
�UITS / FEEDERS
0 to 200 Ampere � $5
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTROL,
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL F
.TIFAMILY DWELLINGS (PER UNI�
3 to 12 Unds �$50 Per Unit
FEES
Center Pivot Irrigation Boom � $
Manulactured Home Park Lots �
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Trar�sformer 1 Power Supply for Signs / Outline Lighting �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and�or Power Supply up to 500 Amperes, All
Gircuits and Two Inspection Trips Each DwelGng Unit �$SC
Additional Ins ection Tri s�$20
Investi ative Fee
Reinsoection Fee � $20
�y� �•7L -cs"—
I I�rebvi cerlifv that I insoectf
total fee is
herein on the
S ial Ins 'on �$30 r Hour '°""'""' / ���� ,c)—� 2,��3 I
Soecial Inspection �$ 31 per Mile �"
THIS INSTALLATION MAY 8E ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFlCE USE ONLY
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Requ t Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspectlon Other Than Rough-In: Ready Now ❑ Wifl Cell
�� °� You must call the inspector when ready! Date Ready:
I certify that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Add�Street, x, or Route No.) C�y � Zi�e �
U
Section Township ange Fire No. County � �
Oxupant
Power Supplier
„� , f..�����,r �.a���o
NDABLE EIECTRIC. iNC.
4 � Co o� � P
RapiAs. MN 55433
ed Signature (Cordre y or Ovn
Number
"-7�0 � �/OSoZ
Number
I � 1 � 3 - �S7-S�r I
EB-00001A-13 7/1/ BOARD OF ELECRiICRV COPY _._ NlSTFiUC710NS ON BACK OF YELLOW COPY