P - 78586REQUEST FOR ELECTRICAL INSPECTION
�.�3 2 2 9 9 Minnesota Board of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MR �QO-627-3529
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. ectncity.state.mn.u�
Identify the work covered by this request: �� � ��. ,et� � ��.��1/G' � �,j� �7� ���
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❑ NEW ❑ REMODEL ❑ ADDITION REPAIR � � � � % �% ��+ �� �;� � � �'�'�
GENERAL F S Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 4� Am re�$25 Su lemental Fee �$20
401 to 800 Am re �$50 Trans(ormers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CiRCUITS / FEEDERS Transfortner / Power Su for Si ns / OuGine ' �$5
0 to 200 Am re �$5 ` ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 2� Am ere �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspecdon Trips Each Dwelli Untt �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S em Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
„ ._ .,. � �_.� �, a�„ o_. � �..:. (minimum total fee is $20)
FEES
Retrofd � $25 per Fodu
'ivot Irtigation Boom � $
tured Home Park Lots �
I herebvi ceAiN thst I inspected the electrp;al installeEOn described herein on the
� � Special Inspection �$30 per Hour I I""""""""' '` I
� Soecial Insoection �$ 31 oer Mile � � �s ^�y
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF T COMPLETED WITFi1N ls nnvN�t+s
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FOp OFRCE I18E ONLY
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Request D te: Rough-in Inspection Required? ❑ Yes o Inspectian Other Than Rough-In: ❑ Ready Now dl Call
�� You must call Me inspector when readyl Date Ready:
I cerqiy that I am the� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of tl�e electrical work at
Job Address (Street, Box, or Route No.) Ciry Z�P C�
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Section Township Range Ffre No. CouMy
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Contrec[or / Company Name
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idress (Contractor, Company or
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EB-00001A-13 7/i/2000
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Contractor License
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OF ELECTRICRV COPY
Master License
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� IN87AUCT101� ON BACK OF YELLOW COPY