P - 81818REQUEST FOR ELECTRICAL INSPECTION
,�' y Minnesota Board of Electricity
��.�, V�� 9 7 9 ��$° 1821 University A,venue Suite S-128; Saint Paul, Minnesota 55104
�° (651) 642-0800 TTY/MRS Y-800-627-3529
www.electricity.state.mn.us
Itlentity the work covered by this request:
[J NEW EMODEL ❑ ADDITION ❑ REPAIR � ��� �]J �� � I � �� � � �
GENERAL FEES Ouidoor Li htin Standard �$1
SERVICES I POWER SUPPLIES TraHic Si nal Standard �$5
0 to 4Q0 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above S00 Am ere �$75 Transiormers over 10 KVA �$20
IRCUITS / FEEDERS Transiormer / Power Su I for Si ns I Outline Li htin �$5
to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dweilin Unit �$BO
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addftional Ins ion Tri s�$20
Each S stem Device or ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee @$20
MULTIFAMILY DWELIINGS PER UNI TOTAL FEE
3 to 12 Unfts �$50 Per Unit (minimum total fee is $20)
Each Additi0nal UnR � $25 F°"'"SP�cro�' °s� °'r�
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fi�ure
Center Pivot Irri atlon Boom �$40
Manufactured Home Park Lots � 5 I he cert' that I inspeded the electrical instaila6on des«ibed herein on tlie dares sfated:
Recreational Vehicle Park SNes 101�' "' °"'�
Se rate Bondin Ins 'on � $2
S ecial In ion �$30 er Hour R""""g"E"10N °A7E
S ial In ion �$.31 r Mile 6—�'-'�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTH�
� ----�—�—.
FOR OFFICE USE ONLY �
i� i ii� � ��� �i��� � ����i ii� � i� � �� .�
IIIII ! III11I I� II
� 1 1 d Z 9 7 9 D�E �
Request Dat :�� Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: �❑ Ready Nax II Call
You must call the inspeclor when ready! Date Ready:
I certiiy that I am the�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Address (Street, Box, or RoYte No.) D� City � Zip�� ��
F
Section Township Range Fire No. County �
�
Occupant �. Phone � �
. ._ �� � � � � �
Power Supplier Address
Electd�81 GooVECtor.LG4mp�y1�18�ECT.� (N�i. CoMrador Li � Num Master License Number
I3LAlIV� 1'i l ta hrtr
i3562 �:ENTRAL AV�. N.E.
Mailing Addres , r Perfortning Installation)
Authorized Sign e(Co tra�tor, n or r Pe in Ilatlon) Pho ��
! '
EB-00001A-13 7!1/2000 ,�BOARD OF ELECTRICRY COPY INSTRUCTIONS ON BACK OF YELLOW COPY