P - 79500REQUEST FOFiELECT,RICAL INSPECTION
1 2 6 0 � 1 2 v Minnesota Board of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
��' (651) 642-0800 TTY/MRS 1-800-627-3529
www.electri ' tate.mn.us
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Identify the work covered by this request t
❑ NEW ❑ IiEMODEL ❑ 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 ere �$50 Transformers u to 40 KVA (� $10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwell' UnR �$8(
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20
Each Svstem Oevice or Aooaratus �$.50 Investiaative Fee
Each Addftional Unit � $25
OTHER ADDITIONAL FEES
Lighting Retrofit � $25 per Fixture
Center Pivot Irtigatlon Boom � $40
Manufactured Homa Park Lots � $25
Recreational Vehicle Park Sites � $5
Separate Bonding Inspection � $20
S ecial Ins ection �$30 r Hour /
S ecial Ins ection �$.31 perMile � ` 2-'—��% �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF N T COMPLETED WITHIN 18 MONTHS
^ FOR OFFICE USE ONLY �
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Reque D��� Rough-in InspecUon Required? ❑ Yes o Inspection Other Than Rough-In: dy Now ❑�II Call
You must call ihe inspector when ready! Date Ready:
I certity at I am the�-tiEENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Add� (Street, Box, � r o� No.) � � Za��LI
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Sechon Township �^�� A Range Fire No. Counry
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total fee is
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I herebvi cerMv that I insoected the electrical insfallation desaibed herein on the dates s�ted: I
� Occupant
ElecVical Con�
Mailfng Address
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Aadress
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rtraCKg� ir Installatia
vRYJiF',_L, P���d '.:�42.�. �
I B-0OOOtA43 7/1@000 . . . ��MD OF E���
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Master license Number
II�TRUC710ti8 ON BACK OF YELLOW COPY