P - 78278REQUEST FOR ELECTRICAL INSPECTION ••
�1 �� 9 01 Minnesota Board of Electriciry
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 J
(651) 642-0800 TTY/MRS 1-800-627-3529 =
www.electricity.state.mn.us '
Identify the work covered by this request: /� , ���
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❑ NEW EMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li hfin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Su mental Fee �$20
401 to 800 Am re�$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su for S' ns / Outline Li htin � a5
0 to 200 Am re �$5 � ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re�$10 Includes the Service antllor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CON'fROL, SIGNALING Circuits and Two Inspection Tri Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addftional Ins ction Tri �$20
Each S stem Device or ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ' n Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE /
3 to t2 Units �$5o Per Unit 6� C��ry✓ (minimum total fee is $20) (s.sU
Each Additional UnR � $25 F0N1N�f0" � °NL'
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r fixture
Center Pivot Irri ation Boom �$40
ManufaCtured Home Park Lots �$25 I hereb cert' that I inspected the electrical insfallation descri h ein on the detes stated:
Recreational VehiGe Park Sftes � $5
�+ n� o�
Se rate Bondin In �on �$20 � ..C,•�---L,_ j�-- �,� O'
S eciai Ins 'on �$30 er Hour """""��°"�" �T�
S 'al I ' � $,31 r Mile � �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED OT COMPLETED WIT N 18 MO THS
FOR OFFICE USE ONLY �� �
I IIlIII IlIII IIlII IIIlI IIIII Illil iNll 11111 {III IIN ��� -
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Request Date: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now ill Call
� You must call the inspector when readyl Date Ready:
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) Ciry Zip Code
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Section Township Range Fire No. ounty
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Occupant Phone
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Power Supplier Address p
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Electrical Contractor / Company e Corrtrador License Number Master License Number
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M�g Address (Contrador Company or Owner Perfortning Installation)
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Authorized S' ature (Contrador, Com y or Owner PeAorming Installation) Phone
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E600001A-13 7/1/2000 BOARD OF ELEC7AICT' COPY INSTRUCTIONS ON BACK OF YELLOW COPY