P - 79722REQUEST FOR ELECTRICAL INSPECTION
` Minnesota Board of Electriciry �
�� 19 7- 8 4 2� 182� University Avenue Suite 5-128, Saint Paui, Minnesota 55104
� ae �� (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us `��'
Identity the work covered by this request:
❑NEW EMODEL ❑ADDITION ❑REPAIR ( j "TG� �' ���� S
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard (� $5
O io 400 Am re �$25 Su lemerrtal Fee C� $20
401 to 8� Am ere �$50 Transformers u to 10 KVA �$10
Above S00 A re �$75 Trar�sformers 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 re�$10 Includes the Service andlor Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling UnR C� $80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri �$20
Each Svstem Device or Aooaratus �$.50 Investiaative Fee
3 to 12 Units �$50 Per UnR �m�nimum totai ree is yzv� / �/
EaCh Add'Rion81 Unit �$25 WP INSPECTOfl USE ONIY
OTHEfl ADDITIONAL FEES
Li htin Retrofit �$.25 r Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots �$25 I hereby certity that I inspected the electrical installation described herein on the dates stated:
Recreational Vehicle Park Sftes � fl01�"'" °"�
S rate Bondin In ection �
S ecial Ins ection �$30 r Hour Fl""""��10N °"'�
S ecial Ins ection �$.31 r Mile
THIS INSTALLA710N MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS __
FOR OFFICE USE ONLY
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Reque Date: RougMin Inspection Required? Yes ❑ No Inspec[ion O[her Than Rough-In: ❑ Feady Now � WNI CaN
� � You must call the inspector when readyl Date Ready:
I certity that I am th�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) C'dy Zip Cod�e /
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Section Township Range Fire No. ounty
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Occupant ��� Phone
Power Supplier Addre
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Electri I Contractor / Compan N me Contractor License Number Master License Number
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Mailing Address (CoMrac[or, Company or Owner Perfortning Installatfon)
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Authorized Si r, Co or Owner Partorming InstaNation) Phone rj�� _�L
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E /2000 BOAHD OF ELECTfi1CT/ COPY IN3TRUCTIONS ON BACK OF YELLOW COPY