P - 80158REQUEST FOR ELECTRICAL INSPECTION
� Minnesota Board of Electricity "� .�,
1�- 3 2 3- 9 5 3� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800- �529
www.electricity.state.mn. �
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Identity the work covered by this request:
❑ NEW ❑ REMODEL ❑ADDITION ❑ REPAIR I • � �-
GENERAL FEES Out oor Li htin Standard �$1
SERVICES I POWER SUPPLIES Tratfic S' nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transfortners u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transiormer / Power Su I for Si ns / Outline � htin �$5
0 to 200 Am re�$5 ONE & TWO FAMILY OWELLWGS, EACH UNIT
Above 200 Am re C� $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATfON, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unfl �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS AddiHonal Ins ion Tri s�$20
Each S stem Device or ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee �$20 _
Y OTHER ADDITIONAL FEES hl�i ��'�7-�Z—
Li htin Retrofit �$25 r Fixture
Center Pivot Irri a6on Boom �$40 °' C°
Manufactured Home Park Lots �$25 � hereby ce � mat I inspec�ed me electrical installation desraited nerein on me dates stated:
Recreatlonal Vehicle Park Sites �$5 p01GN1N °�'�
Se rate Bondi 1 ection �$20
S ecial Ins ection �$30 er Hour '"S"E`"'°"' ��
S ecial Ins ion C� $.31 r Miie
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-I . ady Now 0�II Call
��� �� � You must call the inspector when ready! Date Ready: �
I certify that I am th�10ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Aoute No.) ZP C�
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Section Township Range Fire No. Counry n �
j Occupant
DEP£NDABt£ ELECTRIC, INC�
i d Q�Ln ertorming Installation)
Cson Rapid�. MM 65433
Authorized Signature (CoM , ompa�y or r Performing Instell�
EB-00007A-13 7/1/2000 BOAHD OF
Phone
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nse Number Master
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11�TRUCTION3 ON BACK OF YELIOW COPY