P - 79596REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity � '
1��� ���� ��� °. 1 E21 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� (651) 642-OS00 TTY/MRS 1-800-627-3529
� ��j � � ���� � www.electricity.state.mn.us "���'
ItleMity the work covered by this request:
❑NEW REMODEL ❑ADDITION ❑REPAIR �Q,.�/l��j� ���"���� ��OS
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPIIES Traftic Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Translormer ! Power Su for Si ns / Outline Li htin (� $5
0 to 200 A re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNfT
Above 200 Am ere �$10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelli Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additlonal Ins ection Tri s�$20
Each S stem Device or A ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit �$25 WA �NSPECTIXi USE ONLY
OTHER ADDITIONAL FEES
Li hfin Retrofd �$25 er Focture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots �$J� �� I herebvi cerrtiffv that I inspected the
total fee is
5 ecial Ins ection �$30 r Hour """ '""' �
Special Inspection � $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED OT COMPLETED WITFF
FOR OFFICE USE ONLY
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� (i You must call the inspector when ready! Date fieady:
I cer�iy that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or oute No.) Ciry Zip Code
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Occupant
Power S�
Electrical Contractor / Company Name
a�ur�� Hra. ac E
Mailing Ad ress �
' 7/1/2000
Address
i�N�C.
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Fire No.
Phone
/ CJ/�' ���"
Number I Master License Number
OF ELECTRICITY COPY I, "' �STA� BLvv LLOW COPYI