P - 77622REQUEST FOR ELECTRICAL INSPECTION
1 ' � � � � � � Minnesota Board of Electriciry
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
, — (651) 642-0800 TTY/MRS 1-800-627-3529 - _
www.electricity.state.mn.us �ns 'Vf�9� _.
Idemiiy the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 600 Am re�$50 Transformers u to 10 KVA �$10
Above 800 Am re�$75 Transfortners over 10 KVA �$20
CIRCUITS / FEEDERS Transformer I Power Su I for Si ns / Outline Li Min �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLIN�S, EACH UNIT
Above 200 Am re�$10 Includes ihe Service andlor Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addrtional Ins ion Tri s�$20
Each stem Device or ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$50 Per Unit (minimum total fee is $20)
Each Additional Unit �$25 ��ff�T� USE ONLV
OTHER ADDITIONAL FEES
' ti Retrofit � $25 r Fixture
Cemer Pivot Irti ation Boom �$40
Manufactured Home Park Lots �$25 I hereby certNy that I inspected the electrical installation des«ibed herein on the dates stated:
RecreaGonal Vehicle Park Sites � $5 �"" �''�
Se rate Bondi Ins ion �$20
S ial Ins ction �$30 r Hour FlN4 MSPECTION ) op�
S 'al In �on � $.31 r Mile �._�'"�i ~�— � �� � r
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOH OFFICE USE ONLY � Y�! �� �� �
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Request Date: Rou9h-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: Ready Now ❑�II Call
' �� You must call the inspector when readyl Date Ready: — q���
I certify that I am the T�CI LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecVical work at:
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Job Address (Street, Box, or Route No.) City ZP Code
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E&00007A-13 7/tY2000 BOARD OF ELECTRICRY COPY IN37AUCTIONS ON BACK OF YELLOW COPY