P - 81921REQUEST FOR ELECTRICAL INSPECTION
. % � � Minnesota Board of Electricity ' "�
1� 1� 7� 1 8 1 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�� m (651) 642-0800 TTY/MRS 1-800-627-3529. _
' www.electriciry.state.mn.us �
Identity the work covered by this request:
❑ NEW REMODEL ❑ ADDITION ❑ REPAIR
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 re �$50 Transformers u to 10 KVA �$10
Above 800 Ampere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transtormer / Power Su I tor Si ns / Outline Li htin �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service and/or Power Supply up to 5� Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelli Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20
Each S stem Device or ratus �$.50 Investi tive Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL F
3 to 12 Units �$5o Per Unit (minimum total fee is
EaCh Additional Unit �$25 wa nuPecroR usE a+�v
OTHER ADDITIONAL FEES
Li htin Retrofit �$.25 r Fixture
Center Pivot I' ation Boom �$40
Manufactured Home Park Lots �$25 1 hereby cer6fy thal I inspected the electrical installaiion described herein on tlre � shafed:
Recreational Vehicle Park Sites �$5 fl01G1'" °"�
Se arete Bondi Ins eclion �$20
S ecial Ins 'on �$30 r Hour F0"` M18PC�"�' °ATE
S ial Ins eclion �$.31 r Mile �'����
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WtTHiN 18 MONTHS
FOR OPFICE USE ONLY
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e ate: � Rough-in Inspection Required? ❑ Yes o Inspeclion Other Than R Now � wll Call
You must call the inspector when readyl Date Ready:
I certify that I m the�,410ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request ins 'on of the electrical work at:
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7/1/2000
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Address
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BOARD OF ELECTRICITY COPY
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Master License Number
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- �` -33�5
STRU ONS ON BACK OF YELLOW COPY