P - 76587/ - REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity� a���., ►(�Zlo�/ °�
�� 3 4 7���� 1821 University Avenue Suite S-128, Saint aul, innesota 55104
(651) 642-0800 TfY/MRS 1-800-627-3529 - _
www. electrici ty. state. mn. us
Identify the work covered by this request:
EW ❑REMODEL ❑ADDITION ❑REPAIR
GENERAL FEES Outdoor Li htin Standard (� $t
SERVICES / POWER SUPPLIES Traific Si nal Standard �$5
to 400 Am re�$25 Su mental Fee �$20
401 to 800 Am re�$50 Transfortners u to 10 KVA � S10
Above 800 Am re� S75 Transformers over 10 KVA � a20
CIRCUITS / FEEDERS Transiormer / Power Su for Si ns / Outline Li htin d$5
0 to 200 Am re�$5 � ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service andlor Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$60
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri �$20
Each S stem Device or A aratus �$.50 Investi tive Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$50Per Unit (minimum total fee is $20) �.. �
Each Additional Unit �$25 Fdi INSPELTOR USE ONLY
OTHER ADDITIONAL FEES
Li htin Retrofit �$.25 r Fature
Center Pivot Irti ation Boom �$40 /� .L
Manufactured Home Park Lots �$25 1 he certiy that I inspected the electriql installa6on descri6ed �rein on me aet�
Recreatlonal Vehicle Park Sites � $5 "01GX1N � � ,.,°"'�
te 'on � $20 Z-`j"o y
S ' Ins 'on � $30 r Hour `�'�'` _��---- � - � - C,�.;
S' I In ' �$.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
�`'� � OOS
l illlll illll lilll Illfil IIIII I�III {lill IIIII illl IIN �-� �> s- G�-.�j :. ^
�E 1 3 4 7 5 3 6 3�E �
Reque D e: Rough-in Inspection Required? Yes ❑ No Inspection Other Than Rough-In: '❑ Ready Now Will Call
��(� b.,I You must call the inspector when readyl Date Ready:
I certify that I am the ❑ LICENSED CONTRACTO COMPANY �OWNER and hereby request inspection of the electrical work at:
Job Address (Street„Box, or Route No.)� /� � City % Zip Code
- � ��� �
,� _ �1 , ��� t ; j � r—% "C� ' <�
✓' i.� r! i
Section Tawnship Range Fire No. County
-J � �; , i , /
� , :, � ,,, �
Occupant Pho e ��
, . . /" ! 11� � .Q IQ aSi � — — ._ . . /,% ` . �i
Power Supplier _ ddress
`' � y, �/.i,�/ T ' � i f " • ..__ "' - / / � /
Electrical Contractor / Company Name � Contractor License Number Master License Number
.�'% �.� , `�` f'0—�._c�:5
Mailing Address (Contrador, Compa or Owner PeAorming Installation)
i
Authorized Signa �e �ontrador, Company or Owner Performing Installation) Phone
l- �/ �._. _ �� � �,
EB-OOOOtA-13 7/7/2000 BOApD OF ELECTRICRY COPY INSiAUC71pNS ON BACK OF YELLOW COPY