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P - 79635REQUEST FOR ELECTRICAL INSPECTION 1 2 4 4 O 2 9 mtl � Minnesota Board of Electricity � � ��� 1821 Universily Avenue Suite S-128, Saint Paul, Minnesota 55104 �� � (651) 642-0800 TTY/MRS 1-800-627-3529 ' www.electricitv.state.mn.us " ' ❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR • (//' GENERAL FEES Outdoor Li htin Standard �$1 SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5 0 to 400 Am ere �$25 Su lementai Fee �$20 401 to 800 Am re �$50 Transformers u to 10 KVA �$10 Above S00 Am re �$75 Transformers over 10 KVA �$20 CIRCUITS I FEEDERS Transformer I Power Su I for Si ns / Outline Li hfin �$5 0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT Above 200 Am re �$10 Includes the Service andlor Power Supply up to 500 Amperes, All ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two InspecGon Trips Each Dwellin Unit �$80 CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ction Tri s�$20 Each stem Device or A aratus �$.50 Investi ative Fee ADDITIONS TO THE GENERAL FEES Reins ion Fee �$20 MULTIFAMILY DWELLINGS PER UNI TOTAL FEE 3 to 12 Units �$50 Per Unit (minimum total fee is $2 EeCh Addlti0n21 Unit �$25 FOFi INSPECTOfl USE ONLV OTHER ADDITIONAL FEES N�S�L-�'"� L� htin Retrofd �$25 r Fixture Cemer Pivot t' don Boom �$40 i°a Manufactured Home Park Lots �$25 I herety ce � that I in ed the electrical installetbn described herein on ihe uates stffied: Recreational Vehicle Park Sites �$5 fl01GN �' DA1E Se rate Bondin Ins io� �$20 S ial Ins 'on � $30 er Fbur �tl°�"1BPE°f01 � � � S ecial Ins ion �$.31 er Mile � THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS FOR OFFICE USE ONLY � III�I� �II�I I�lI� IIlII I�ill NI�� IIIII I�II� IIII IIII �e �f 1 c'' 4 4 O c 9 3 3E � O� �� J�U Request�: Rough-in Inspection Required? [] Yes ❑ No Inspection Ottier Than Rough-In: - eady Pfow � Nfifl Cali D� You must call the inspectar when ready! Date Ready: I cerlify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elscUicai work at Job Address (Street, or Route No.) C Zip Cotle � � _ � �c,�� _S� .,�, S�f/`3� Township Au[horized E&00007A-13 IC. INC�, 1 n r Performing No. Counry Phone 1 e� + ;Z _ _ i Conhactor License S-7/ -y' � ��3 � �zs7 s�� I BOAND OP ELECTRICRY COPY INSTpUCT10N3 ON BACK OF YELLOW COPY