P - 79891REQUEST FOR ELECTRICAL INSPECTION
� � � � � � � mP . Minnesota Board of Electricity
� � � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
°�� ��; (651) 642-0800 TTY/MRS 1-800-627-3529 -
www.electricity.state.mn.us '��
Identify the work covered by this request: �^
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR (i(/L �i /? Ct.(;�Zr �/ l { � ��lC.. �
GENERAL FEES Outdoor Li htin Standard (� $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$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
C RCUITS / FEEDERS Transfortner / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re (� $10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin UnR �$SO
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri �$20
Each S stem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee �$20
MULTIFAMILY DWELLINGS PER UN TOTAL FEE
3 to 12 Unfts �$50 Per Unit (minimum total fee is $2
Each Additional Unft � $25 F0f1N��0R1�01�`'
OTHER ADDITIONAL FEES
Li hti Retrofit �$25 er Fixture n�����
Center Pivot Irri ation Boom �$40 /�
Manufactured Home Pa�tc Lois �$25 I hereby cerMy uiat I inspected the electrira� installaUOn drscribed herein on �e dates srated:
Recreational Vehicle Park Sites �$5 f01GN1N °ATE
Se rate Bondi Ins ion �$20
S'al Ins ion (� $30 er Hour f°�°��10N DA7E
ial In ion �$.31 r Mile �— �� 8—
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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V cerliy that I am the ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection oi 1he eieclrical work at
Job Address (St Box p� � I� S�/��-� C� L�/� Zip e ^
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Section Township Range Fre No. Couniy
Authorized Signatur
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E6-00001A43 7/1/2000
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ripany or Owner
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BOApD OF ELEC7AICf1Y COPY
Number Master License Number
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INSTRUCTIOP� ON BACK OF 7ELLOW COPY