P - 79599.r�` � - REQUEST FOR ELECTRICAL INSPECTION
� � � � � � � � � Minnesota Board of Electricity
� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
a,� � (651) 642-0800 TTY/MRS 1-800-627-3529
www. e lectricity. state. mn. us
Identity the work covered by this request: �'�, �� ��
EW ❑ REMODEL ❑ ADDITION ❑ REPAIR �
GENERAL FEES Outdoor Liohtina Standard ��1
0 to 400 Ampere � $25
401 to 800 Am ere (� $50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am re �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUlTS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus �$.50
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$70
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two inspection Trips Each Dwellin Unit �$6(
Additional Inspection Triqs t� $20
total fee is
OTHER ADDITIONAL FEES
Li hti Retrofit �$25 er Fixture
Center Pivot Irri ation Boom �$40
Manufach�red Hame Park Lots �$25 I hereby ca � mat I ins the electrical installation described herein on aie dates stated:
Recreational Vehicle Park Sites �$5 "W0H1N DA7E
Se arate Bondin In ion �$20
S ecial Ins ection �$30 er Hour �"'�fON �/ °"'�
S ial In ion �$.31 r Mile � (��J
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF COMPLETED WITHIN 18 MONT
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspaction Required? ❑ Yes o Inspection Other Than RougMln: Ready Now ❑�11 Call
� O You must call the inspec[or when readyf Date Ready:
I certi(y that i am the�CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of d�e electricai work at
Job Address (Street, Box, or Route No.) CNy Z�P �°�
R:� (� CXP�� � S�1
Section Township Range Fire No. Co nry/�
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I Power
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7/1/2000
or Owner Pertorming
Phone
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Contractor License Number Master License Number
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Installation)
BOARD OF ELECTRIC(TY COPY
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INSTAUC710N8 ON BACK OF YELLOW COPY