P - 78341REQUEST FOR ELECTRICAL INSPECTION
1- �`� 7 3 3 g � Minnesota Board of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn. us
IdentiTy the work covered by this request:
❑NEW ❑REMODEL �CDDITION �REPAIR � `���1C U�� �uSC b%(
GENERAL FEES Outdoor Li Min Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am re�$75 Transfortners over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 ro 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 Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri �$20
Each S tem Device or A aratus �$,50 InvesU ative fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE F,
3 to t2 Units f� $50 Per Unit inimum total fee is $20) 'r
EaCh Addftionel Uf11t � $25 � �"S��ON �� °�v /��„/( � u �
OTHER ADDITIONAL FEES
Li Min Retrofit �$25 r Fixlure
CeMer Pivot Irri ation 800m �$40 �� p*„ _,,d ) A,��--/i�o�
Manufactured Home Park Lots �$25 I hereby cert that I ins ea the cal inS�dlfS6dlf e�.MbedTierein the detes smted:
Recreational Vehicle Park Sites � $5 '�"" ��
Se arate Bondin Ins ion �$20 ��
S ecial Ins ection �$30 r Hour FlNAL INSPECTION ��� � c�
S ial Ins tion �$.31 r Mib
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN �8'MONTHS
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? es ❑ No Inspection Other Than Raugh-In: ❑ Ready Now ill Call
9��'o� You must call the inspector when ready! Date Ready:
I certiiy that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY [t�WNER and hereby request inspection of the electrical work at:
Job Atldress (Street, Box, ocRoute No.) City 7rp Code
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Section Township Range Fire No. County
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Occupant Phone
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Power Supplier / Addre � `
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Electrical Contracto Company Name � p 4 9 Contractor License Number Master License Number
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Mailing Address (Contractor, Company or Owner Perfortning Installation)
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Authorized ' nature (Contractor, Company or Owner Pertorming Installation) Phone� � I�_�� ��� ��'
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EB- -13 7/t/2000� BOARD OF ELECTRICITY COPY INS7AUCTIONS ON BACK OF YELLOW COPV