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P - 79535REQUEST FOR ELECTRICAL INSPECTION 1�81 2 8 5 P s Minnesota Board of Electricity - a � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 ��e��� (651) 642-0800 TfYIMRS 1-500-627-3529 ` www.electricity.state.mn.us Identity the work covered by this request: ❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR 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 Am ere (� $50 Transformers u to 10 KVA �$10 Above 800 Am re �$75 Transformers over 10 KVA �$20 CIRCUITS / FEEDERS Transformer I 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 and/or Power Supply 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�$20 Each S stem Device or ratus �$.50 Investi ative Fee ADDITIONS TO THE GENERAL FEES Reinspection Fee (� $20 3 to 12 UniLs �$50 Per Unit Each AddRional Unit � $25 OTHER ADDITIONAL FEES Center Pivot Irrigatbn Boom � $4( Manufactured Home Park Lots � $ Rec�eational Vehicle Park Sites � Separate Bonding Inspection � $2i Soecial Insoection � $30 oer Hour /c/K- q-i�.�-L total fee is installation described herein on the dates � S �r THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS FOR OFFlCE USE ONLY I Il�lli 11111IIIII Illli IIIII filli Illll IIIII III! �lil � � z� � z� 5 5* %�#��9� ao,sa Request Date: Rough-in Inspection Required? ❑ Yes ❑ No' Inspection Other Than Rough • Now ❑ Will Cal� �� � You must call the inspector when readyl Date Ready: I certiiy that I am tHe;�kIEENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elechical work at: Job Address (Street, Box, or Route No.) A ZP �� � _ /_ i . n • // ��_/� _ OccupaM PoWe� s� �� EB-00001A-13 0 � Range Fire No. 29� - � Address Phone �� 3 -s�i ��s,s' Contractor License Number Nner Performing Installation) or r Perfortning Installalion) � BOARD OF ELECTRICITY COPY b `7s'� .�9d I INSTRUC710NS ON BACK OF YELLOW COPY