P - 80075REQUEST FOR ELECTRICAL INSPECTION
1 3 0 6 � 11 �T Minnesota Board of Electricity °�
� � �� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
. e�°� � (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us
{dentify the work cavered by this request: i�� S 1_ o� j�, �,� e„ ti.� �, � �
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NEW ❑ REMODEL ❑ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES I POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su for Si ns / Outline Li htin �$5
0 to 200 Am re�$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 2� Am ere �$10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit �$SO
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each Svstem Device or A�oaratus �$.50 Investigative Fee
,MILY DWELLINGS (PER UNIn
12 Units � $50 Per Unit
� add�nor,� u�n � $2s
OTHER ADDITIONAL FEES
ing Retrofit � $25 per Fixture
er Pivot Irtigation Boom � $40
�factured Hane Park Lots � $25
eational Vehicle Park Sites � $5
rcate Bonding Inspection � $20
:ial Insoection � $30 cer Hour
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I insoeaed the elechical
total fee is
on Me dates �ed:
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THIS INSTALLATION MAY BE ORDeRED �iscvNwecreo iF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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RequaSt Date: Rough-in Inspection Required? ❑ Yes No Inspectfon Other Than Rough-In: Ready Now [] WiN Cafl
�� ��— � You must call the inspector when readyl Date Ready:
I certi(y that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) City ZP �
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Sec[ion Township Range Fire No. Coun
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Power Supplier Address
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Electrical Contractor / Company Name � Contractor License Number Maste icense mber
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Mailing Address (Contractor, Company or Owner Performing Installatio� /� //�_ � j� I,��
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Authori ignatu ntrac[or, Co or Owner Performing Installation) Phone
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-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUC710NS ON BACK OF YELLOW COPY