P - 78298REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
�+•s 3 4, 7� 3 6 O 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 1?Y/MRS 1-800-627-3529 =
www. electri ci ty. state. mn. us
Identify the work cover y this request:
❑ NEW EMODEL ❑ ADDITION REPAIR Q e � I� e (y' G�O `� v� C� U S�
GENERAL FEES Outdoor Li htin Standard �$t
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 �$50 Transfortners u to 10 KVA �$10
Above 800 Am re�$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su for Si ns / Outline Li hti �
0 to 200 Am re �$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, SIGNAI.ING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ction Tri s�$20
Each S em Device or aratus �$.50 Inves6 tive Fee
ADDITIONS TO THE GENERAL FEES Reins 'on Fee �$20
MULTIFAMILY DWELLINGS PER UNI r TOTAL FEE y��
3 to 12 units �$5o Per Unit 0� (minimum total fee is $20) Olo.
Each Additbnal Unit � $25 � . fOfl1"�"E`�0fl1� °NLY ,� £;�' _ % 3 7- � � � L
OTHER ADDITIONAL F ES � -�'p�'�� �— �i'{f�j'
�
Li htin Retrofit �$25 r Fixture � h. � y`� 2�� � y��� /�, ��� �
Center Pivot Irri atbn 800m �$40 `� /
Manufactured Home Park Lots � a25 I hereb ce' that I inspec[ed the electrical insiallaUOn described herein �es s�aced:
Recreatlonal Vehide Park Sites �$5 .� �GH M DAIE
rate Bondi Ins 'on � a20 1 �-'i Q3
S ial Ins �on �$30 r Hour """` / DA7E
' In ' �$.31 rMile � �`ia� /�-1��"P
THIS 1NSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPL WITHIN 18 MONTHS
,_, v FOR OFFICE USE ONLY __ �� —
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I certi(y that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY .�OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
6� �` i r �°�.! le� Ss43
Section Township Range Fire No. Cou
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Occuparrt Phone
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Power Supplier Address
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Electrical Contrador / Company Name CoMractor License Number Master License Number
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Mailing Address (Contractor, Company or Owner Performing h/ i
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Authorized Signature (Contrador, Company or Owner Perfortning Installation) Phone
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EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTAUCTIONS ON BACK OF YELLOW COPY