P - 77259REQtJ'�ST FOR ELECTRICAL INSPECTION
Minnesota Board of Eleahcity — � '
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1� 3 4 7- 4 7 7 1821 University A�enue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 =
www.elecMciry.state.rnn.us `' '
Identify the work covered by this request:
❑ NEW ❑ REMODEL �ADDITION ❑ REPAIR
GENERAL FEES
SERVICES I POWER SUPPLIES
0 to 400 Am ere �$25
401 to 800 Am re �$50
Above 800 Am re � $75
CIRCUITS I FEEDERS
0 to 200 Am re �$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SI
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
(K�h �ia �` °f C_` ��
Transfortners u to 10 KVA � 570
Transformers over 10 KVA � $20
Transfortner / Power Supply for Signs I Outhne Lighting �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unft �$8(
muLiirMmiu vrv���u�vo rcn
3 to i2 uniGS �$5o Per Unit (minimum total fee is 20)
Each Additional Unit � $25 � "'��'�" �� �"Y - � � � �G
OTHER ADDITIONAL FEES �� �
Li htin Retrofit �$.25 r Fixture �u� l!/�jnqg /�� � rx I
Center Pivot I' ation Boom � E40 �'*+ ��< J v
Manufactured Home Park Lots �$25 I hereby ce ' that I inspected the electrical installa6on described herein on the dates stated:
� � onh
Recreational Vehicle Park Sites � $5
S rate Bondin Ins ion �$20 �„�
S ial Ins 'on �$30 r Hour F'"A` �"sr�`�o" -�-
ial Ins an �$.31 r Mile �� � I��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHI 18 MONTHS
FOR OFFlCE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rou9h-In: Ready Now � Will Call
�� Z�^ 0� You must call the inspec[or when ready! Date Ready:
I ceRify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY �OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) Z�p �O�
?� �'�' � �i � civ �/E °�'F� i v� � � s5 y � 2.
Section Township Range Fire No. County
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Phone
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Power Supplier Address
i�rrir.w� ontractor /� anv Name Contractor License Number Master License Number
Address (Contractor, Company or Owner PeAortning Installation)
�ed ignatu (Contra y or ner Pe �o ing Installation)
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4-�3 ����2000 BOARD OF ELECTRICITY COPY
Phone
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INSTRUCTIONS ON BACK OF YELLOW COPY