P - 81731, REQUEST FOR ELECTRICAL INSPECTION
' Minnesota Board of Electricity _
.- 1-375-730 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529
www.electricity.state.mn.us � �
Identify the work covered by this request: �„v�' `� J,„� F�,�,�,�_.
EW ❑ REMODEL ❑ ADDITION ❑ REPAIR �
GENERAL FEES utdoor Li htin an ard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Ampere �$50 Transformers u to 10 KVA �$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNAUNG """""' °"" ' °" "'°""""°" • •''" ---" - ` ' - -
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS Additlonal Inspection Trips �$20
Each System Device or A paratus C� $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee �$20
MULTIFAMILY DWELLINGS (PER UNIT) �. . S—U TOTAL FEE 3�.Si%
3 to 12 Units �$50 Per Unit (minimum total fee is $20)
EaCh Add'll'lOnal Unit �$25 � FoR wsaecroa us� oN�v
OTHER ADD�TIONAL FEES
Li htin Retrofit �$25 er Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots �$25 I hereby certrfy thai I inspeded the electncal instslletion descnDed herein on the Cetes slated:
Recreational Vehicle Park Sites �$5 FOUGM IN °ATE
Se arate Bondin In ion �$20
S ial Ins ection �$30 per Hour F'"'"'"s�°"°N oATE
S ial Ins ection �$.31 er Mile �� � t
Tu�c_�NSTOLI._�Tl(]N�IIAY 9EAR� RFn 1'NC _pNN CT D IF N T G�YPLETED WITHIN 18 MONTHS .�
FOR OFFICE USE ONLY
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* 1 3757307* ��r�0
Request Date: Rough-in Inspectlon Required? ❑ Yes o Inspection Other Than Rough-in: eady Now ❑ Will Call
3-� a. �' � � You must call the inspector when ready! Date Ready:
I certi(y that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route NoJ Ciry Zip Code
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Section Township Range Fire No. Cou
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Occupant Phone
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Power Supplier Address
Electrical Contractor / Company Name Contractor License Number Master Lice�lse Number
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Mailing Address (CoMractor, Company or Owner Performing Installation)
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Aut rized ' e(C ra r m an r 'n Installation Phone � �
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- 0001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY