P - 78709REQUEST FOR ELECTRICAL INSPECTION
1 3 3 7 7 6 � � Minnesota Board of Electriciry
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
. (651) 642-0800 TTY/MRS 1-800-627-3529 �
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� �.....
www.electricity.state.mn.us �,� 1
Identify the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
0 to 400 Am ere �$25
401 to 800 Am ere �$50
Above 800 Am ere � $75
CIRCUITS 1 FEEDERS
0 to 200 Am ere �$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CO
CIRCUITS, CIRCUITS OF LESS THAN 50
Each S em Device or ratus �
ADDITIONS TO THE GE�
MULTIFAMILY DWELLINGS PER UNI
3 to 12 UniGs �$50 Per Unit
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transfomiers over 10 KVA � $20
Trensfortner / Power Su for Si ns / Outline Li hd �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unil �$8C
Addiuonal Inspection Trips � $20
Investiaative Fee r
fee is
Li htin Retroffi �$25 r Fxture
Center Pivot Irri aUon Boom (� $40
Manufactured Home Park Lots �$25 � nereby cert� that I in aed nre electrical insrallation describea herein on me dates sta�ed:
Recreational Vehicle Park Siles � $5
�+, w wh
S rate Bondin Ins 'on � $20
o�re
S ial In an �$30 er Hour ^7
S ecial In ' �$.31 r Mile G` Z
THIS INSTALLATION MAY BE ORDERED DISGONNECTED NOT COMPLETED WITHIN 18 MONTHS
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Request �� Rough-in Inspection Required7 ❑ Yes Inspection Other Than Rough-In: eady Now � Wfll Call
You must call the inspector when readyl Data Ready:
I certiTy that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the eledrical wak at ii
Job Address (Street, Box, or ute No.) �Y I��v*'/►./ ZiP �°d���
.s�r- �t/� T s
Sec[ion Township ange Fire No. Counry
� OccupaM � _ J
� / Company Name
:N VAL,LEY
�
82 WEST 6
3a240
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h I Master Ll�nse
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�. 763-535-2000 .
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