P - 77418REQUEST FOR ELECTRICAL I,p�SP C ON� ���
�� J��- 5 3 8 Minnesota Board of Electricity C ��b� �j
1821 University Avenue Suite S-128, S�t Paul, Minnesota 5 1 /
(651) 642-OS00 T'fY/MRS 1-800-627-3529 =
www. electricity. state. mn. us
Identify the work covered by this request: Q�� J,^^ � g � J_/► � V
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❑ NEW ❑ REMODEL ❑ADDITION REPAIR
GENERAL F S Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Tra(fic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am re � S50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su for Si ns / Outline Li Min �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service and/or Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Tri Each Dwelli Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ction Tri �$20
Each S em Device or ratus �$.50 Invesf tive Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE �-y�
3 to 12 UnRs �$50 Per UnR (minimum total fee is $20) 3� J✓
Each Additional Unit � $25 F0fl "�T�" � ��
OTHER ADDITIONAL FEES
Li htin Fetrofit �$.25 er Fixture
Center Pivot Irti ation Boom �$40
Manufactured Home Park Lots �$25 I hereby certity that I inspected the electrical installation described herein on the dates stated:
Recreational Vehicle Park SRes �$5 i01N'" �' o��
S rate Bondin I ion �$20
S'al In 'on �$30 r Hour F'a'1 "s�°"a' �o�TE /�
S'al Ins 'on �$.31 er Mile �--'� ZJ�—�a '
_ THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFlCE USE ONLY
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Request Date: �� Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-In: �eady Now ❑ Will Call
�_ �`� You must call the inspector when readyl Dale Ready:
I certity that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or qoute No.) City Zip Code
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Section Township Range Fire No. County
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Occupant Phone
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Power Supp�r Address � /
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Electrical �ontractor / Com any me Contractor License Number Master License Number
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Mailin Address (Contractor, Company or Owner Perfortning Installation)
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Auth ized S nature (Contra , ny rtortning Installation) phppe �� ^� �
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EB-0OOOlA-13 1/2000 BOMD OF ELECTAICRY COPY MISTpUCT1pNg pll gACK OF YELLOW COPY