P - 81710REQUEST FOR ELECTRICAL INSPECTION �
k, � Minnesota Board of Electricity
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1��%� ����� �� 1821 University Avenue Suite S-128, Saint Paut, Minnesota 55104
� (651) 642-0800 TfY/MRS 1-800-627-3529
www. electricity. state. mn. us
Identiiy the work covered by this request:
❑NEW ❑REMODEL ❑ADDITION ❑REPAIR//'-I'{IxCJ �'"^"''''
407 to 800 Ampere �
Above 800 Amoere �
0 to 200 Ampere � $5
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTROL,
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device a Apparatus �$.50
ADDITIONS TO THE GENERAL f
Each Additional Unit � $25
OTHER ADDITIONAI FEES
Manufactured Home Park Lots �
Recreational Vehicle Park Sites �
Seoarate Bondina Insoection � $�
Outdoor Li htin Standard � $1
Traffic Si nal Standard @ $5
Su lemental Fee � $20
Transtormers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su i for Si ns I Outline Li htin �$5
ONE & TWO FAMlLY DWELLIMGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
CircuiGs and Two Ins ection Trips Each Dwelling Unit �$8C
Additional Ins ection Tri s�$20
Investi ative Fee
Reinsoection Fee C� $20
I insoected the
total fee is
on tlie dates stated:
Special Inspection �$ 31 per Mile � v" ` �- 2 2-o�
� THIS INSTALLATIOM MAY 8E ORDERED DISCONNECTED !F NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: eady Now Wltl Call
/
7' Q' You must call ihe inspector when ready! Date Ready:
I certify that I am the ICENSED CONTRACTOA ❑ COMPANY ❑ OWNER and hereby request inspection of the elecfical work a�
Job Address (SVeet, Bo , or Rou[e o City � ZP � ��
car.rcnn Tnwnshiu Ranoe Fire No. ' CounN i
OccupaM ..
Power Supplier
ConVad�r / Company Name
PENDABLE ELECTRIC.
, � ap4dr�#s�
�n Rapids, MN�55433
3d Signature (C ctor, Company or C
�
� EB-00001A43
Phone '
�
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Conbactor License Number
�nsranaU«,>
ning Installation)' I
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