P - 81579REQUEST FOR ELECTRICAL INSPECTION
f�%� °� Minnesota Board of Electricity "Y�
�� V"1. 8� 5 5 7 �"� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OS00 TTY/MRS 1-500-627-3529
www. electricity. state.mn. us
IdentiTy the work covered by this request: � �y y'� � �'1 ' �
❑NEW ❑REMODEL ❑ADDITION REPAIR �Z L ' 1 (,.� '
GENERAL FE S Out r Li hti Stand d(� $1 ,
SERVICES / POWER SUPPLIES Traitic 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
CIRCUITS / FEEDERS Transformer I 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 ere �$10 Incfudes the Service and/or Power Suppty up to 500 Amperes, AA
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S stem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins�ection Fee �$20
OTHER ADDITIONAL FEES
Retrofit � $25 per Fi�ure
'ivot Irrigation Boom � $40
tured Home Park Lok � $25
onai Vehicle Park Sites �, �
� Bonding Inspection �
Inspection � $30 per Hour
Insoection � $.31 oer Mile
total fee is
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I frerebv ceAifv Mat I inspected the elecUical inslailation describetl herein on the
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FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes : o Inspection Other Than Rough-In: ❑ Ready Now 0 Will Call
�%-� You must caN the inspector when ready! Date Ready: �, g Q
I cert' that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) CKy� Zp Code
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Address (Contrador, Company or
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EB-OOOOtA-13 7/1/2000
Phone
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CoMrector License Number Master License Number
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'erf ing Installation) ,/�
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�Instelfation) Phone
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BOARD OF ELECTRICRY COPY 9JSTAUCTION3 ON BACK OF YELIOW COPY