P - 79692REQUEST FOR ELECTRICAL INSPECTION
� Minnesota Board of Electricity -
���� 8��, 8� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� e (651) 642-0800 TTY/MRS 1-800-627-3 9
www.electricity.state.mn.us ��
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Identify the work covered by this request:
❑ NEW REMODEL ❑ ADDITION ❑ REPAIR 1 C7v �4/ �. � `f � � �� ��`"� $
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Trensformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA f� $20
CUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li hbn �$5
to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$t Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING CircuiGs and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS AddiUonal Ins ion Tri s�$20
Each S stem Device or A ratus �$.50 Investi tive Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to �2 Units �$5o Per unit (minimum total fee is $20) �
Each Additional Unit �$25 F°" w�°T°p'uE °"`''
OTHER ADDITIONAL FEES �'YN-�''-"OZ
Li htin Retrofit �$25 er Fixture .
Center Pivot Irriaation Boom � S40 A/1 �_
nSpeCtiOn � $21
� $30 pQf HOUf
� $.31 oer Mile
I N�I I ri� N�erie� YMbfon d�b�d Mwin m the dates stated:
N DAIE
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NNECTED IF NOT COMPLETED WITHIN 18_MONTH$___ _
FOR OFFICE U8E ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-tn: ❑ Ready Now'��. Wilf Call
� You must call the inspector when ready! Date Ready:
I certi(y that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of tt�e electrical work at:
Job Address (Street, Box, or R No.) Ciry Zip Code
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S'on Towns ip Range Fire No. County
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Elec[rical CoMractor / Company Name Contractor License Number Master License Number
BIAIN� HTd. A/C ELECT. iNC.
Maih pertorming InsTallation)
ANOKA, MN 55304
Authorized Si a (Cont or, r Perfortning�ln lation) PFrone
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E&00001A-13 7/1/2000 � BO D OF ELECTRICRY COPY INSTRUCTONS ON BACK OF YELLOW COPY