P - 77569. REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity °'°`'`
1��'�F 1- 5 0 4 �82� Universiry Avenue Suite S-128, Saint Paul, Minnesota 55704
(651) 642-0800 TTY/MRS 1-800-627-3529 - _
www.electricity.state.mn.us �i�r,� D�lc./�
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Identity the work cover by this request:
�IEW EMODEL ❑ADDITION ❑REPAIR ��'�.C.�-c{' �ta
GENERAL FEES Outdoor Li htin Standa �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard (� $5
0 to 400 Am re �$25 0 Su lemental Fee �$20
401 to 800 Am re (� $50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transfortners over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �
0 to 200 Am re �$5 , ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re � $10
RM, COMMUNICATION, REMOTE CONTROL, SIGNALING
;UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
TIFAMILY DWELLINGS (PER UNI�
3 to 12 Units �$50 Per Unit �
Each Additlonal Unit f� $25
OTHER ADDITIONAL FEES
Li htin Retroffi �$.25 er Fixture
Center Pivot Irri� ation Boom �$40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites � $5
Se arate Bondin Ins ection �$20
Soeciallnsoection � $30 oer Hour
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$8L
Add'Rional Inspedion Trips � $20
Investiaative Fee
ihat I
total fee is
on the dates stated:
� f� � � �
THIS INSTALLATION MAY BE ORDERED DiscoNnecreo iF n� � cunnr�t � tu w�THIN 18 MONTHS
FOR OFFICE USE ONLY _� � �aJ
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Request Date: Rough-in Inspection Required? es ❑ No Inspection Other Than Rough•In: eady Now � Will Call
.�- J � D You must call the inspector when ready! Date Ready: �'— � �J
I ceAify that I am the �"CICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
EB-OOOOtA-13 7/1/2000 BOAHD OF ELEC7AICfTY COPY MISTRUCTIONS ON BACK OF YELLOW COPY