P - 78518< REQUEST FOR ELECTRICAL INSPECTION
C� � � Minnesota Board of Electricity �
1�- 3 4 7�� 1�J ° 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
'�� � (651) 642-0800 TT`(/MRS 1-800-627-3529 �
www.electricity.state.mn.us
IdentiTy the w rk covered by this request: � � i��
❑NEW REMODEL �ADDITION ❑REPAIR
GENERAL FEES Outdoor Lighti Standard �$1
0 to 400 Ampere � $25
401 to 800 Ampere � $50
Above 800 Ampere � $75
�UITS ! FEEDERS
0 to 200 Ampere � $5
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTROL,
CUITS, CIRCUITS OF LESS THAN 50 VOITS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL F
to 12 Units �
Irrigation Boom �
I Home Park Lots
Vehicle Park Site:
Transformers u to 10 KVA �A �to
Transformers over 10 KVA � $20
Transformer / Power Supply for Signs ! Outline Lightin9 �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Indudes the Service anNor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each DweNin Uni[ �$6(
Additional Ins ection Tri s(� $20
Investi ative Fee
Reinsoection Fee � $20
(minimum total fee is $20) •
FOP INSPECTOfl USE IX�Y C.,�� y 1. n
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I herebvi ceAiN that I inspected the elec[rical installaGon descdbed herein on the dates stated:
Special Inspection �$30 per Hour �_J `"""""�"'"'" � � �,,,�y I
� Soec�al Insoechon �$ 31 Der Mile �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
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R Dat : Rough-in Inspedion Required? Yes ❑ No InspecGon Other Than Rough-In: Ready Now 0 Will Call
� You must call the inspeIXOr when r dy. Date Ready:
I certiiy that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspectiai of the electrical work at:
Job Address (Street, Box, r oule o.) Ci ZP �
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Section Township � Rang� Fire No. Counry �
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Company qr Owner P� �
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ctor, Company or Owner Performing
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EB-0OOOtA-13 7/1/2000 BOAAD OF ELECTRICITY COPY
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Master License
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Phone
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INSTNUCTWNB ON BACK OF YELLOW COPY