P - 82468REQUEST FOR ELECTRICAL INSPECTION ��'�
�1 � ° Minnesota Board of Electricity
1�`.J;` 6� 9 5 1 a'�q, 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
' �� � (651) 642-0800 TTY/MRS 1-800-627-3529
www. electriciry. state. mn. us
IdentiTy the work covered by this request: j^ �/'� `
f;) �❑ NEW EMODEL ❑ ADDITION ❑ REPAIR s
GENERAL FEES Outdoor Li htin S andard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS I FEEDERS Transfortner / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service andlor Power Suppty up to 500 Amperes, All
ALARM, GOMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two InsQection Tdps Each Dwell' Unit �$8U
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri �$20
Each S stem Device or A ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MUITIFAMILY DWELIINGS PER UNI TOTAL FEE
3 to 12 Units f� $5o Per Unft (minimum total fee is $PO) �
EBCh AddtlOf121 U�it �$25 ����Tap USE ONLV
OTHER ADDITIONAL FEES
Li htin ReVofit �$25 r Fixture
Center Pivot Irri tion Boom �$40
Manufactured Home Park Lots �$25 I hereb cert' mat I in cted the electrical installadon described herein on tl�e dates stated:
Recreational Vehicle Park Sites � NOUGN IN ��
Se arate Bondin Ins 'on � $2
S ecial Ins ction �$30 er Hour �""LN3PEL'"�' wh
S ecial In ection �$.31 r Mile
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__ THIS INSTALLATION MAY BE._ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS _
FOR OFFlCE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes Inspec[ion Other Than Rough-In: ❑ Ready Now ill Call
— You must caN the inspector when readyt Date Ready:
I certi(y that I am the ' ICENSED CONTHACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Addre St t, x, or Route No.) C' ZiP Code
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Section Township Range Fire No. Co
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ant /j� Phone
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Power Supplier � a
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Electrical �/��1(fAan�9lgn� �C��yY �.. Contracto License Number Master License Number
13502 CEtVTRAL :�.;/;'. �?.-: `�
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Mailing Address CoMra or, pany o P r% Performing Insiallation)
Authorized i ature ( Mra pany or Qnmer Performi lation) Phone
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E&OOOOtA-13 7/7/2000 B AHD OF ELECTRICRY COPY � INSTRUCTIONS ON BACK OF YELLOW COPY