P - 79688, REQUEST FOR ELECTRICAL INSPECTION
`� —^��- A�^ P m Minnesota Board of Electriciry
� �,�• [ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�E ��, (651j 642-OS00 TTY/MRS 1-800-627-3529 '
www.electriciry.state.mn.us ��j���
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identity the work covered by this request:
❑NEW EMODEL pADDITION ❑REPAIR � %1�,�,r� ��l''�17
�ENERAL FEES Outdoor Li htin Standard C� $i
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transiormers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
RCUITS / FEEDERS Transformer I Power Su I for S' ns / Outline Li hti �$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, REMO7E CONTROL, SIGNALING Circuits and Two Inspection Tri s 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 Inves6 ative Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee �$20
MULTlFAMILY DWELLINGS PER UNI 70TAL FEE /�
3 to 12 Units �$50 Per Unit (minimum total fee is $20) ,�f
EaCh Addltlonal Uf11t �$25 FOP INSPECTOq USE OIMY
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fixture
Center Pivot Irri tion Boom �$40
Manufactured Home Park Lots �$25 I hereby ce ihat � inspected the elecuical installa6on described herein on tlre dates smt�:
Recreallonal Vehicle Park Sites � $5 �" �" �+�
Separate Bondina Insoectlon � S20 �t ) ►-
rriis INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MQNTHS __
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes o Inspection Ofher Than Rough-In: ❑ Ready N Will Cail
`�� You must catl the inspector when readyl Date Reatly:
I cerMy that I am the LICENSED CONTRAC70R ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Address (Street, ox, or Route No.) Cily Zp Code
g iSS�" i �-
Section ownship Range Fire No. County
Occuparrt � � r- Phone
J - �7r- 30
Power Supp ier Address
Electric�l C�qqt[�cy/,�ynp�py,�larqa. �►T�� �NC. Contrector License Number Master License Number
Lil�l�ll4 1'7117 J'1/V CL
1356? CENTRAL AVE. N.E.
Mailing Addres �C r Perfortning Installation)
Authorized Sig (Cont or, pan er Perfortning I lation) Phone �/
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EB-00001A-13 7Ii/2000 BO OF ELECTRICRY COW INSTRUC710NS ON BACK OF YELLOW COPY