P - 79523REQUEST FOR ELECTRICAL INSPECTION
1 �`� � � � � � 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.stute.mn.us
identify the work covered by this request: '
❑NEW ❑REMODEL ❑ADDITION ❑REPAIR �(,��1..�'� l��Ct-(.,:k C �
�
GENERAL FEES Outd Li htin Standard �$1
SERVICES I POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee (� $20
401 to S00 Am ere �$50 Transformers u to 10 KVA (� $10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
C CUITS / FEEDERS Transformer / Power Su I for Si ns I Outline Li htin �$5
0 to 200 Am ere �$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 Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20
Each S stem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee (� $20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units @$5o Per Unit (minimum total fee is $2
Each Additional Unit �$25 FOR II�PECTOfl USE ONLY
OTHER ADDITIONAL FEES
Li htin Retro�t �$25 r Fixture
Center Pivot Irri ation Boom �$40
MBnufaCtufOd HOme Pafk Lots (� $25 - I hereb certify that I inspected the electrical installation described herein on the dates stated:
Recreational Vehicle Park Sites �$5 noucH �N oA*�
Se arate Bondin Ins ection �$20
S cial In ion �$30 er Hour "�""�`"0"' °��
S ecial In ection f� $.31 er Mile � l� a
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
I IIIIII IIIII Illli 11111 illil Illli 11111 IElll 11111111 ��.���
�� e 7 e� e� 6 � ��SC7
Re D Rough-in Inspection Required? ❑ Yes o inspection Other T an ugh-In: ow ��A Call
You must call the inspector when readyl Date Ready:
I ceRiiy that I am the ENSED CONTRACTOR _❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Power Supplier
Electrical C r/ Company Name
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Mailing Address Cont ctor, Com eny
Authorized S) nature ( ntractor, C m
! i � �
C% . Ja
EB-00001A43 7/1/2000
County
.e` �� �
�`'r �' • Contractor License Number Master License Number
� � �L-- "�
sr Perf rming Installation) �
� � � ,�1 s� 1.�.�1.���
Owner PerfDrming Ins Ilation) P one ���
s !
BOARD OF ELECTRICIT! COPY � IN37AUCTIONB ON BACK OF VELLOW COPY