P - 78589REC�UEST FOR ELECTRICAL INSPECTION
1 3 51 0 8 9 A Minnesota Board of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www.elec ca�tate.mn.us
Identify the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR y ` � "' 1 �
GENERAL FEES Outdoor Li htin Standard �$1
SEAVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re (� $25 Su lemental Fee �$20
401 to 800 Am re �$50 Trensformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transfortner / Power Su for Si ns / OuUine Li 'n �$5
0 to 200 Am ere �$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
ve 200 Am ere �$10 Includes the Service andlor Power Suppty up to 50Q Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Ins ion Trips Each Dw i Unit �$BO "
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addi�onal In ion Tri �$20
Each S stem Device or A ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee �$20 _
IFAMILY DWELLINGS (PER UNIn
to 12 Units �$50 Per Unit
ich Additional Unft � $25
OTHER ADDITIONAL
Pivot Irtigation Boom � $4U
ctured Home Park Lots � $
bonal Vehide Park Sites � ;
te Bonding Inspection � $2(
Insoection � $30 oer Hour
I hereby cerMy mat I
total fee is
herein on
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INSTALLATION MAY BE ORDERED dSCONNECTED IF NOT COMPLE7ED wlTrt�rv it3 mun � ns
— — — -- — FOR OFFICE USE ONLY
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Request D� Rough-in Inspection Required7 ❑ Yes �VO Insp6Ction U[ne� � nan nougn-m: �nauy �.�.. u••"' �� I
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You must call the inspec[or when ready! Date Ready:
I ce�ify that I am the CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electricai work at:
Job Address (Sheet, Box, or Route No.) Cily T�p Code
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Section Township Ra Fre No. CouMy
OccupaM
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Power Supplier
Electrical Contra�%
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Mailing Address ( �I
Autho ' Signa re
E 1A-13 7A/2000
Phone
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BOARD OF ELECTRICITY COPY
Phone
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Number
WSTRUCTIONS ON BACK OF YELLOW COPY