P - 81865REQUEST FOR ELECTRICAL INSPECTION
.� O� 7 ��� tl s Minnesota Board of Electricity —
�� � 1821 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 thi eque �
❑ NEW ❑ REMODEL ❑ ADDITI � REPAIR /��� � � �ili(� �� � �
GENERAL FE S Outdoor Li htin Standard �$1
SERVICES ( POWER SUPPLIES Traflic Si nal Standard �$5
0 io 400 Am ere �$25 Su lemental Fee �$20
401 to S00 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Tri s Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ction Tri s�$20
Each S stem Device or A aratus �$.50 ' Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinsoection Fee �$20
3 to 12 Units �$50 Per Unit �minimum io�ai �ee is yco�
Each Additional Unit �$25 FOR MSVECTOq USE 0lbY
OTHER ADDITIONAL FEES
Li tin Retrofit �$25 r Fixture
Center Pivot Irri ation Boom �$40
ManufactuPed Home Park Lots � I her ce' that I ins ed tl�e electrical insNallation described herein on the detes stated:
Recrea6onal Vehicle Park Sites � "a"'"'" °�'�
arate Bondi los (� $20
S ial Ins ection �$30 er Hour "�""�"`�"«' /r �DA7E
S ial Ins ection �$.31 r Mile �� �� `'�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED I OT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspedion Required? ❑ Yes No Inspection Other Than Rough-In: Ready Now [] Will Call
— �� You must cal! llie inspeqor when ready! Date Ready:
i certiiy that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work ai
Job Address (Street. x. or Route No.l � � "-° �� --- � --- � �� Zfo Code 1 _ . �
� Section � Township `� � Range
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7/1/2000 BOAiiD OF ELECTRICITY COPY INSTRUCTpNS ON BACK OF�YELL COPY