P - 79530REQUEST FOR ELECTRICAL INSPECTION
t n %n Minnesota Board of Electricity �°=°
1� 2 0 5�`t 1't 0� 182� University Avenue Suite S-128, Saint Paul, Minnesota 55104
_ ��° � ° (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us
Identity the work covered by this request: �y
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❑NEW �iEMODEL ❑ADDITION ❑REPAIR C /W� V �
GENERAL FEES Outdoor Li htin Standard (� $i
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA (� $10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CI CUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
to 200 Am ere �$5 ONE & 1W0 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 Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20
Each S stem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE ��
3 to 12 Units �$5o Per Unit (minimum total fee is $20)
EeCh Additional Unit �$25 FOF INSPECTOq USE ONLV
OTHER ADDITIONAL FEES
Li tin Retrofit �$25 er Fi�Rure
Center Pivot Irri ation Boom (� $40 -
Manufactured Home Park Lots �$25 !" I hereby certiiy that I inspected the electrical inslalla6on described herein on the � stated:
Recreational Vehicle Park Sites �$5 R01�" �' °"`�
Se rate Bondi !rts ' � $20 �
S ecial In ion �$30 er Hour F1'_"""�`�"0"' � °"'�
S ecial Ins ection �$.31 er Mile ��Z"
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFlCE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: ❑'Ready Now �11 Call
�� You must call the inspector when ready! Date Ready:
I certiiy that 1 am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work ai
Job Address (Street, Box, or Route No.) City Zip Code
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EB- A-13 7/1/2000
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INSTRUCTIONS ON BACK OF YELLQW COPY