P - 79812REQUEST FOR ELECTRICAL INSPECTION
'[ Minnesota Board of Efectricity �
��� J O- 6 6 6 �� 6 182� University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-6273529
www.electricity.state.mn.us J� � � "�'
Identify the work covered by this request:
❑ NEW REMODEL ❑ AdDITVON ❑ REPAIfl � D�% � 1 �- S ' �� � � � � J
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su plemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere l� $75 Transformers over 10 KVA �$20
IRCUITS / 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 Suppiy up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20
Each S tem Device or aratus �$.50 Investi atrve Fee
ADDITIONS TO THE GENERAL FEES Reins ' n Fee �$20 __ ___
3 to 12 Units (� $50 Per Unit
Each Addftionai Unit � $25
OTHER ADDITI01
Liqhting Retroffi � $25 per Fixture
Center Pivot Irtigation Boom � $4(
Manufactured Home Park Lots � y
Recreational Vehicle Park Sites Q
I herebvi ceAifv that I inspected the electrical
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herein on Nre
� � Special Inspection �$31 per Mile I I � �— — ��`—" r
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
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FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes No Inspec[ion Other Than Rough-In: ❑ Ready No Will Call
� 1/ � You must call the inspector when readyl � � �Date� Heady: � � �
I certi(y that I am the LICENSED CONTRACTOR ❑ COMPANY. ❑ OWNER and hereby request inspection of the electricai work at:
Job Addr�ess (Street. Box, �Route No.) ,�,� � � Cityr'. � � Zip Code , -
I Section I Township �Q
Occupant
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Power S�
Mailing Address
Authorized Siam
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EB-OOOOtA-13 7/1/2000
Fire
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ame Contractor License Number Master License Number
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or, pa er Perfortning allation) Phone
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BO D OF ELECTpICRY COPY INSTFiUCTION3 ON BACK OF YELLOW COPY