P - 78102REQUEST FOR ELECTRICAL INSPECTION
�.. —�� 0� 7� 8 � Minnesota Board of Electriaty -
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
GENERALFEES
SERVICES / POWER SUPPLIES
0 to 400 Am ere $25
401 to 800 Ampere � S50
Above B00 Ampere p E75
CIRCUITS I FEEDERS
0 to 200 Ampere @ SS
�Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS G
Each System Device or Apparatus � 3.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @ E50 Per Unit
Each Additional Unit @ S25
OTHER ADDITIONAL FEES
Li htin Retrofit $25 er Fixtu2
Center Pivot Irri ation Boom $40
M�ufaclured Home Park Lols E25
Recreational Vehicle Park Siles 55
arate Bondin Ins tion $20
S 'allr� 'on j30 Hour
'allns 'on 5.31 Mile
THIS INSTALLATION MAY BE ORDER
��I III�I IIIII III�I III�I IIIII �IIII IIIII N� I�III
1 5 8 0 7 3 81,
TraHic Signal Standard
Supplemental Fee @ $
Transformers uo to 10 I
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, Ali
Cirouits and Two Inspection Trips Each Dwelling Unit @$80
( TOTALfE; I "� �('
minimum total fee is $20 01 � `
THrs u� Fors rcs�croa usE arar
I hereby cer6y that 1 inspected the ekchrkal installation descnbed herein on tlie dates sfa[ed:
�5' /a-� a�
r��
NOT COMPLETED WITHIN 12 MONTHS
G/� �13�7
,(� '�D 7U
v��-S�
�9�� `/0 � I RougMn Inspection Required? ❑ Yes ��Tlo InspeGion Other Than Rcwgh-In: ❑Ready Now ❑ Will Call
S �C
Yau must call the inspector when ready! Date Ready:
�
I certify that I am tt�e �ICENSED CONTRACTOR OCOMPANY ❑ OWNER and hereby request inspection of the electrical work at:
..--•�,••.••••••�•••• �••,.••••r •�.�.+....�. evwRO oF e�cTwcm coPV EB-00001M14 e.�. 2002