P - 77431REQUEST FOR ELECTRICAL INSPECTION
% ,� Minnesota Board of Electriciry �Q��'- �a��%S'^'
1; � 1 4- 9 71 182� University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 =
www.electricity.state.mn.us
Identity the work covered by this request: I� �
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❑ NEW ❑ REMODEL ❑ ADDITION EPAIR
GENERAL FEES Outdoor Li hti Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re(� $25 Su lemer�tal Fee �$20
401 to 8U0 Am re �$50 Transfortners u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns I Outline ' hG �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALIN� CircuiGs and Two Inspection T� Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS AddRional Ins ection Tri s�$20
Each S em Device or A ratus �$.50 Investi tive Fee
ADDITIONS TO THE GENERAL FEES Rein 'on Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$5o Per Unit (minimum total fee is $20) �
Each Additional Unit @ $25 F01 "�Ta' � �Y
OTHER ADDITIONAL FEES
Li hd Retrofit �$25 r Fi�Rure
Center Pivot I' ation Boom �$40
ManufaCtured Home Park Lots �$25 1 hereby cerMy that I inspected the electricat installation described herein on the dates stated:
Recreational Vehide Park Sites � $5 �"" �T�
S arate Bondin Ins 'on � $20
S ecial ins ection �$30 er Hour Fl""""��"01 �*�
S ial In ' �$.31 r Mile �"�--�` �' g�o
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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neques[ ua[e: Hough-in Inspection Required? ❑ Yes �IVo Inspection OTher Than Rou h-In:
rs s ❑ Reacy niow m ca�i
You must call the inspector when readyl Date Ready:
I certify that I am he �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job�s �S� t, Bo , o Route �) � �� City P'Q Zip�� �
Section Township Range ire No. �^
c�C' o� L'l , ����v�-=-�- :�;/l%4 i �
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Power plier � Address
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E 'cal C tractor / Company Name �� Cont r Licens
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Mai� Address (CoMrador, Com r Owner P orming stallat�'on) ,
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Authorized S' (Contra or, Co ny or e Performing Installation)
E A-13 7/1/2000 BOAHD OF ELEC7AICfTY COPY
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Number Mast � License Number
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INSTRUCTIONS ON BACK OF YELLOW COPY