P - 81803REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity ''`=�
1. � 0 61- 7 6 4� �6 11) 642-08 0 ATTY/MRS11 00-6273529Paul, Minnesota 55104
www.electricity.state.mn.us �.� SG
Identify the work covered by this request: ; �VI� �
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❑ NEW REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Liahtina Standard � 1
SERVICES / POWER SUP
0 to 400 Am ere ��
401 to 800 Am ere �
Above 800 Am�ere �
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTROL, SIG
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
TIFAMILY DWELLINGS (PER UNI'�
3 to 12 Units C� $50 Per Unit
Each Additional Unit f� $25
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
7ransformer / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$80
Addftional Inspection Trips � $20
Investi ative Fee
Reinsoection Fee � $20
total fee is
Manufadured Home Park Lots �$25 I here ce' that I in tl�e electrical installatiai described herein on the � sfated:
Recreational Vehicle Park Sites � "�"" DA1E
Se arate Bondi In ion �$2 �" �- o
S ecial Ins ection �$30 r Hour F""� "�f01 �— °� �,
ial I edion �$.31 r Mile ���
TIiIS INSTAILATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTNS
FOR OFFICE USE ONLY
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� /�Q'7 �(�� � You must call the inspecto� when ready! � Date Ready: ' � �
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1 certify that ! am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe electrical work at
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Job�tl ss (Street, Box, or Route No.�' � vt 7r����/
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Section Township Range Fire No. ounty
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Oocupern , Phon �0Z
Supplier A dress
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Electrical Contractor / Company Narqe Contractor License Number Master License N mber
or
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'' ed Signature (Con a, Compan a w" Rormj�fnst�Ngti — � PhprAs
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�-13 7/1/2000 L ARD OF ELECTAICITY COPY INSTRIICTiOkB ON