P - 80087REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1���r� - 0 3 5 „� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�� (651) 642-0800 TTYIMRS 1-800-627-3529
wrvw.electricity.state.mn.us �� �
Identity ihe work covered by this request: .��
❑ NEW ❑ REMODEL ❑ ADDITION REPAIR
GENERAL F S Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 �'c� Su lemental Fee (� $20
401 to SUO Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS ! FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 A re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 2W Am re �$10 Includes the Service and�or Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALNdG � Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOITS Additional fns ction Tri s�$20
Each S stem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins tion Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE -�7,�
3 to 12 units �$5o Per una (minimum total fee is $20) !�J
EaCh Additi0�81 U�it �$25 � WR �MSPECTOfl USE ONLV
OTHER ADDITIONAL fEES
Li htin Retrofit (� $.25 er Fixture �
Center Pivot Irri aUon Boom �$40
Manufactured Home Park Lots C� $25 � here cerGly mat � inspecced cne e�ecUical irxta�la6on described herein on me dates stated:
Recreational Vehicle Park Sites �$5 q01GH1N °ATE
Se arate Bondin Ins 'on � $20
S eciaf Ins ection �$30 er Hour 1f1L1B�"01 . Q^ ) DA1E
S eciai Ins ection �$.31 r Mile a�! �' d��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED T COMPLETED WITHIN 18 MONTHS
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FOR OFFICE USE ONLY �i p^�} „(` �,
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Request Date: Rough-in I�pection Required? ❑ Yes ��lo Inspection Other Than Rough-In: eady Now � Wifl Cell
You must call the inspector when ready! Date Ready: Q
l certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY �WNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) City Zip Cade
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Section Town ip Range Fire No. Co nty
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OccupaM � Phone
S-{�U-� e 7 3-�t� -o S
Power Supplier Address
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Electrical Contrador / Comp y ame Corrtractor License Number Master license Number
Mailing Address (Contractor, Company or Owner Performing tnstallation)
Authorized Signature (Contredor, Company or Owner Perfortning Installation) Phone
EB-0OOOlA-13 71172000 BOARD OF ELECTAICRY COPY INSTRUCTIONS ON BACK OF YELLOW COPY