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P - 79829REGIUEST FOR ELECTRICAL INSPECTION � �� ° Minnesota Board of Eleciricity � � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 � .e. (651) 642-0800 TTY/MRS 1-800-62 � www.electricity.state.mn.us ,�S Identify the work covered by this request: �� ❑ NEW p REMODEL ❑ ADDITION ❑ REPAIR � GENERAL FEES Outdoor Li htin Standard �$1 SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5 0 to 400 Am ere �$25 Su lemental Fee �$20 401 to 800 Am ere �$50 Transformers u to 10 KVA �$10 Above 800 Am re �$75 . Transformers over 10 KVA �$20 RCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5 0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UfVIT Above 200 Am ere �$10 Includes the Senrice anNor Power Suppty up to 500 Amperes, All ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Ins ection Trips Each Dwelling Unit �$80 CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS AddRional Ins 'on Tri �$20 Each S tem Device or A raius �$.50 Investi ative Fee ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20 MULTIFAMILY DWELLINGS PER UNI TOTAL FE 3 to 12 UnRS �$50 Per Unit (minimum total fee is Each Additi0nal Ut1it �$25 %OR INSPECTOfl USE ONIV OTHER ADDITIONAL FEES Li htin Retrofd �$25 r Fixture Center Pivot Irri ation Boom �$40 Manufactured Home Park Lots �$25 I hereby ce thffi I inspecled me electrical insrallaGai desaibed herein on me detes stated: - Recreational Vehide Park Sites � $5 "�"" °"'� S rate Bondin Ins ion � S20 S ecial Ins ion �$30 er Hour F""""�Q"0N �� S� U3 S ial Ins ion �$.31 r Mile THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS ____ FOR OFFICE USE ONLY I111I�II4111I�IlilllllllllllllllllllllLII�II11411R Q�3�� 4 1 3 O 9 9 4 9 4 3E i�� sa Req e)/� _/j Rough-in lnspection Required? ❑ Y lnspection Ofher Than Rough-1 � ow � W+11 Call � �� You must call the inspector when readyl Date Ready: I certi(y tl�at I am ih ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: Job Addr (Stre , Box, or Route o.) Ciry �� J Zip C� %�. ion Township Range • Flre No. CouMy pccuparh Pho �� \Iri .J�� f� Power S r Elect ' Contractor / Company Name Contrac[or License Number Master License Number ,�-- I,�- �1� l 2� MaiT ress (C redor, Compa or Owner Perjorm`ng Installa� � � � �� n. /\ /� [iVIJ Yl A rized igna re Cont Compan� or Owner Perfo ' slallallon) Phone l� _ 1 �� 27�' �� EB-00001A-13 7/i/2000 BOMD OF ELECTRICRY COPY INSTFiUCTiON3 ON BACK OF YELLOW COPY