P - 78315REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity '`�`°
1� 3 4 7- 4 21 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. state. mn. us
Identi(y the work covered by this request:
❑NEW .EMODEL ❑ADDITION ❑REPAIR S �r��- �-�'9 �� ��J�
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traific 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 re �$75 Transformers over 10 KVA �$20
CIRCUITS I FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am re �$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Tri s Each Dwelli UnH �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20
Each S stem Device or ratus �$.50 Inves6 ative Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee �$20
MULTIFAMILY DWELLIN�S PER UNI TOTAL FEE
3 to 12 Units �$50 Per Unit (minimum total fee is $20) .��°
Each Addltbnal Unit � $25 �""�G0R1�0NLY
OTHER ADDITIONAL FEES ����"' �, � � �
Li htin Retrofit �$25 er Fixture
Center Pivot I' tion Boom �$40
M3�1uf2CtUr9d HOmB Park LOtS �$25 I hereby cer6fy thet I inspected the electrical installation described herein on the dates stated:
Recreational Vehicle Park Sites �$5 fD1f"'" °"'�
S rate Bondin I ion �$20
S ial In 'on �$30 r Hour �"''"`�"""0N y °"'�
S' In 'on �$.31 r Mile `L�'�" a�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFlCE USE ONLY ��r� // �
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R est Date: Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now Will Call
�'��� v You must call the inspector when ready! Date Ready:
I certify 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 Zip Code
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Section Township � O Ra�� Fire No. County ���
Occupan ^ j �C� j j�I : Phone� �� ��/ �� A�
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Power Supplier Address
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EI cal Contractor / Company Name Contractor License N m r Master License Number
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Mailing Address (Contractor, Company Owner Performing Installation)
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AWtw' natur (Corrtrado Com any or ner P rtorming s a on) Phone
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E&00001A-13 7/i/2000 � ApD ELECTHICRY COPY INSTRUCTIONS ON BACK OF YE W COPY