P - 80093REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity "
1� 3 2 6- 9 4 5 ��;� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
- � �m (651) 642-0800 TTY/MRS 1-800-627-3�29 � ��
www.electricity.state.mn.us � '' '
.
IdentiTy the work covered by this request:
❑ NEW REMODEL ❑ ADDITION ❑ REPAIR Q, � �� � O U�
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Ampere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere � $75
�UITS / FEEDERS �
0 to 200 Ampere � $5 '
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTROL, SIGI
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
.TIFAMILY DWELLINGS (PER UNI�
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
LighUng Retrofit � $25 per Fixture
Center Pivot Irrigation Boom (� $40
Manufactured Home Park Lots � ll6A �.�
� $30 cer Hour
Transformers over 10 KVA � $20
Transformer I Power Su I for Si ns / Outline Li htln �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Ci�cuits and Two Inspection Trips Each Dwellin Unit �$8f
Additional Inspection Trips � $20
Investiaative Fee
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I nerenvi ce�tifv that I insoecled tlie electrical insfallatan
total fee is
— 2-73— 03 I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITNIN 18 MONTHS
FOR OFFICE USE ONLY
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Req Date: RougMin Inspection Required? ❑ Yes No Inspection O[her Than� Rough-In: Ready N I Call
D� V Q You must calV the inspectm when ready! Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of tl�e electrical work aY.
Job Address (Street, Box, or Route No.) City ZiP C�da
VY �"' "^ J I �V� i�� l�
Section Township Range Fire No. Cou
Occupar� �tn
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Power Supplier
BI.AIN� HTG. i
Mailing Address , �o�C
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ELECT., INC.
License
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Number
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7/i/2000 �� ARD OF ELECTRICRY COPY INSTRUCTIONS ON BACK OF YELIOW COPY