P - 78683REQUEST FOR ELECTRICAL INSPECTION
=1 3 4 7 3 � 9 Minnesota Board of Electriciry
o � 1821 University A+�Ite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 T'fY/MRS 1-800-627-3529 =
www. electrici ry. state. mn. us
IdentiTy the work covered by this request:
❑ NEW EMODEL ❑ ADDITION ❑ REPAIR � V O . S�
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am re f� $50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transfortners over 10 KVA �$20
CIRCUITS / FEEDERS Transfortner / Power Su for Si ns / Outline Li htin �$5
0 to 200 Am re�$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re�$10 Includes fhe Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Ins ection Trips Each Dwelli Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri �$20
Each S em Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Rein ion Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE � ,`
3 to 12 Units �$5o Per Unit (minimum total fee is $20) J.SV
Each Additional Unit �$25 wR��s�cronus�«nY �� / 1���( �.�`��
OTHER ADDRIONAL FEES S�i� r/[.C.l dcT
' hU RetraM � $25 � F��� <.,� /�.r_,�-1 h ° �` `SA
CeMer Pivot I' abon Boom �$40
Manufactured Home Pa�k Lots � I hereby cerlify that I inspected the electrical installation described herein dn the dates stated:
Recreational Vehicle Park Sftes � P01C�' °' �'�
Separate Bondin Ins ection �$20 �(� = d3
S ial Ins bn �$30 er Hour �"'""�"0N °��_c
S ecial Ins ection �$.31 er Mile � \�r� 7
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFRCE USE OMIY
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Request Date: Rough-in Inspection Requi�ed? �Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now �WIII Call
QYou must pll the inspector when ready! Date Ready:
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY �WNER and hereby request inspeciion of the electricai work at
Job Address (Street, Box, or Route No.) City Zip Code
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Section Township Range Fire No. County
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Power Supplier Address
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Electrical Contractor / Company Na Contractor License Number Master License Number
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Mailing Address (CoMractor, Company or Owner Performing Instellation)
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Author' Signature (Contrador, Company or Owner Performing Installation) Phone
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EB-OOOOtA-13 7/1/2000 BOARD OF�ELECTRICT' COPY INSTHUCTIONS ON BACK OF YELLOW COPY