P - 81629REQUEST FOR ELECTRICAL INSPECTION
' Q �� Minnesota Board of Electricity —
1��� V- 4 3 8� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
. (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us "�''
identify the work covered by this request:
❑ NEW ❑ REMODEL ❑ADDITION ❑ REPAIR (/'� �"`� h �I.w
GENERAL FEES r li htin Standard �$1
SERVICES I POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
IRCUITS / FEEDERS Transformer / Power Su I for Si ns I Outline Li htin (� $5
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, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Inspection Tri s�$20
Each S stem Device or ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ecfion Fee (� $20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$50 Per Unif (minimum total fee is $20)
Each Additional Unft �$25 wR ir�c�crofl use roav
OTHER ADDITIONAL FEES �G,/—
Li htin Retrofit �$25 er Fixture � �_ v l
Center Pivot Irr' ation Boom �$40
Manufactured Home Park Lots �$25 I hereby certify that I inspected ihe eledrical installatian descr�ed herein on the daies stated:
Recreational Vehicle Park Sites a N01�"" °ATE
S rete Bondin Ins ection �
S fal Ins �on �$30 r Hour iL1/LNS�"0N DA7E
S ial Ins ection �$.31 er Mile �% "'Ot "��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFlCE USE ONLY '' I�,m 1/
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Requ st Da : Rough-in Inspection Required? ❑ Yes Inspection Other Than ougMln: dy Now ❑ Will Call
You must call the inspectw when readyl Date Ready: ` g
I certi(y that I am the CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request spection of the electrical work at:
J�d�ss,(Street, x, rRouteN�� City � ZpCode_
° � l 55�
Section Township Range Fire No. County
���I �,�� 5�.�-G.�,rl c� P�,e � 7 i-?�.32
Name V V V V 1 CoMractor License Number
G�it c. c� (�.� � �? C
npa or Owner Performing Installation)
1 A� ��1 I� i n�hh�-. S-� o�
Master License
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E&00001A-13 7/1/2000 BOApD OF ELECTRICfTY COPY .. INSTAUCTIONS ON BACK QF YELLOW COPY