P - 81884REQUEST FOR ELECTRICAL INSPECTION
b Minnesota Board of Electricity
���� ��� 3� 8 ,� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
t, (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us
Identify the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR � �
GENEPAL FEES Outdow � hti Standa�d 8$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25
401 to 800 Am ere �$50
Above 800 Ampere f� $75
CIRCUITS / FEEDERS
0 to 2�0 A re �$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE Cd
CIRCUITS, CIRCUITS OF LESS THAN 50
Each S stem Device or A ratus �
ADDITIONS TO THE GEP
MUITIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
� Retrofd � $25 per Fatw
Pivot Irrigation Boom � $
ctured Home Park Lots �
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transtortners over 10 KVA � $20
Transformer / Power Su for S' ns / Outline Li htln �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 500 Amperes, All
SIGNAIING Circuits and Two Inspeetan Tri s Each Dwell' Unit �$B(
Additional Insoection Trips � $20
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ebvi ceAM1v thffi I insoected the
total fee is
aa�es sm�d:
S ial Ins 'on �$30 r Hour """"' �"'-
Speciad Inspectio� � $.3t per Mile /� %`"� '�3
THIS INSTALLATION MAY BE ORDERED DISCONNECTED I COMPLETED WITHIN 18 MONTHS
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Reque Date: .�� Rough-in InspecHon Required? Yes ❑ No Inspection Other Than Rough-In: Ready Now � Will Call
You must call the inspector when ready! Date Ready:
I ceAify mat I am the LiCENSED CONTAACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Address (SVe , r Route No. City Zip Code
/�/ / �
S ion Township Range Fire No.. County � �
Occupant _ � �L / Ph<L� -
s
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Power Supplier Address
Eleetricat CoMra r/ omparry Name Contrador license Number
E,PENDABLE ELECTRIC:INC.
�q (� C�� o�er Pertorming Installation)
oon Rapids. MN 5
Authorized Signa ntractor, Company or Owner Pe rtning Inslallallon) Phc
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INSTRUCTiON3 ON BACK OF YELLOW COPY