P - 78505REQUEST FOR ELECTRICAL WSPECTION
1� 3 4 7��� 6 m Minnesota Board of Electriciry
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� 0 (651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. state. mn. us
❑NEW MODEL ❑ADDITION ❑REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am ere �$25
401 to 800 Am e�e �$50
Above 800 Am re � $75
I CUITS / FEEDERS
0 to 200 Ampere � $5
CIRCUITS OF LESS THAN 50 VOLTS
ystem Device or Apparatus � $.50
ADDITIONS TO THE GENERAL FEES
LY DWELLINGS IPER UNITI
-� � c� ��, �-
Outdoor Liahtina Standard � $1
Su lemental Fee (� $20
Transfortners u to 10 KVA �$10
Transfortners over 10 KVA � $20
Transformer / Power Su tor Si ns / OuUine Li htin � a5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Insp�.�ction Trips Each Dwelli Unit �$8(
Add'Aional Inspection Trips � $20
Investiaative Fee
total fee is
_.._.. -_.--.� OTHER ADDITIONAL FEES a GUY— G�"�"7�
Li hti Rehofrt �$25 er Fature �-� �,O �
Cerner Pivot I� adon Boom �$40
Manufactured HOm2 Patk LOts �$25 I h ' tl�t I inspected the ekCtrical insfallatian describ� herein an the dates s�ed:
RecreaGonal Vehide Park Sites �$5 "d10XN y DA1E�[
Se rate Bondin Ins ion �$20 / 2^ t�%^ V 7
S ecial Ins eclion �$30 r Hour �'" "�"'�' °ATE
S ecial Ins ecGon �$.31 r Mile �—! 3^ O
THIS INSTALLATION MAY BE ORDERED DFSCONNECTED iF NOT COMPLETED WITHIN 18 MONTHS
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FOR OFFICE USE ONI.Y ,�� I.
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Request Date: Rough-in Inspecdon Required? ❑ Yes ❑ No InspecUOn Other Than Rough-In: Ready Now ❑�II Call
You must call the inspector when ready! Date Ready:
I certity that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY �OWNER and hereby request inspection of the electrical work aY
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Section Township Range Fre No. County
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Power Supplier Address
Electrical Cont�tor / Compagy{Name CoMractor License Number Master License Number
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Mailing Address (CoMractor, Company or Owner Performing InsTellation)
AWhorized Signature (Contractor, Company or Owner Perfortning Installation) Phone
EB-OOOOtA-13 7/1/2000 BOARD OF ELECTRICRY COPY INSTAUC710NS qJ BACK OF YELLOW COPY