P - 79548-�� REQUEST FOR ELECTRICAL INSPECTION
�- 2 6 6- 5 01 � Minnesota Board of Electricity
� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� ° `� �
� � (651) 642-OS00 TTY/MRS 1-800-627-3529 `�
20�3aoo . wwN'•electricity.state.mn.us
Identity the work covered by this request: / it�1 `V`�C � v' �� ��G.
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❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traftic 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 re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transfortner / Power Su I for Si ns / Outline Li htin �$5
0 t� 200 Am ere �$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Inciudes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S stem Device or aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$50 Per Unit (minimum total fee is $20) Q��
EaCh Addition8l U�it (� $25 FOP INSPECTON USE ONLY
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fi�ure
Center Pivot irri ation Boom �$40
ManUfBCtur2d Home Park LotS �$25 I here certify that I inspected the electricai insqlla6on described herein on the dates stated:
Recreational Vehicle Park Sites �$5 fl0 " °"'�
Se rate Bondin In ion �$20 � M�^�'Z
S ecial Ins ion �$30 er Hour �"'8°E°"0N ,,/ °"'�
S ial Ins ection �$.31 r Mile ��[, "��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 NTHS
FOR OFFlCE USE ONLY
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Reques Date: Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now Call
��30 loZ„ You must caB the inspector when ready! Date Ready:
I ceRi(y that I am the [�CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (SVeet, Box, or Route No.) City Zip Code
3 5o I�'� �o�e .5�. icl� F�t.rd S .3.2
Section Township Range Fre No. County
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CoMrac[or / Com�anv Name
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EB-00001A-13 7/1/2000 �
License
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BOARD OF ELECTRICITY COPY
License
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INSTpUC710NS ON BACK OF YELLOW COPY