P - 78507REQUEST FOR ELECTRICAL INSPECTION
' Minnesota Board of Electricity
` 1- 3 4 7- 3 9 8 p �821 ����ers,ty A�en�e S��te S-,28, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 � jj -
www. electriciry.state.mn. us (J
Identify the work covered by this request: /j (j� � ��
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❑NEW REMODEL ❑ADDITION ❑REPAIR
GENERAL FEES Outdoor Li htin Standard $1
S ES / POWER SUPPLIES ° - Traffic Si nal StandaM �$5
to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIACUITS / FEEDERS Transformer / Power Su I for Si ns I Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING CircuiGS and Two Inspection Trips Each Dwellin Unft �$BO
RCUITS, CIRCUITS OF LESS THAN 50 VOLTS � Additional Ins ection Tri s�$20
Each S em Device or ratus �$.50 investi ative Fee
ADDITIONS TO THE 6ENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI T�T� �
3 to 12 Units �$50 Per Unit (minimum total fee is $20)
Each Addftional Unit � $25 `�'�PE°'°"usE°"`v
OTHER ADDITIONAL FEES
Li hh Retrofit �$25 r FnRure
Center Pivot Irri ation Boom �$40 ' ��/ �
Manufactured Home Park Lots �$25 I hereby ' mat I in ed the electrical instailaaon described he on e'�ates stat :
nour++ m o�re
Recrea6onal Vehicle Park Sites (� $5 � K` 7� _�„`
Se arate Bondin In ion �$20 �� �
S ial Ins ection �$30 r Hour ""� "�"0" �.���
S ial Ins ection �$.31 er Mile � G�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
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Req Dat : Rough-in Inspection Required? Yes ❑ No Inspealiion Otlier Than Rough-In: ❑ Ready Now ill Ca�l
� * You must call the inspector when rea ! Date Ready:
I certi(y ihat I am the ❑ LICENSED CONTRACTOR ❑ COMPANY NER and hereby request inspection of tlie electrical work at:
Job A �x or R�Nq� °1 �� ^ � City � � ZP � � / � 'j
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Section Township� O Ran�� Flre No. Couniy �� �/ n
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Occupant � � / � � O � Ph / � � y /
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Power Suppf r Addre � ��� � , )'
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Electrical Con / Company t�ame � � CoMrector License Number Master License Number
Mailing Address (Contr �, c:ompany or
Authorized Signature (Contrador, Co
EB-OOOOtA-13 7/1/2000 �
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MSTRUCTIONS ON BACK OF YELLOW COPY