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P - 81673REQUEST FOR ELECTRICAL INSPECTION �_��O A� O Minnesota Board of Electricity °� �� , a 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 � �` ��, � (651) 642-0800 lTY/MRS 1-500-627-3529 www. e lectricity. sta te. 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 ere ��25 Su lemental Fee �$20 401 to 800 Am re �$50 Transformers u to 10 KVA �$10 Above 800 Am ere �$75 Transformers over 10 KVA �$20 CIRCUITS / FEEDERS Transformer / Power Su I fw Si ns / Outline Li htin �$5 0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT Above 200 Am re �$10 Includes the Service and/or Power Supply up to 500 Amperes, All ALARM, COMMUNICATION, REMOTE CON7ROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80 CIRCUITS, CIRCUITS OF IESS THAN 50 VOLTS Additional Insoection Trios �$20 Each System Device or Apparatus �$.50 ADDITIONS TO THE GENERAL FEES .TIFAMlLY DWEL!lNGS (PER UNI'� 3 to 12 Units �$50 Per Unit Each Additional Unit � $25 Fee � total fee is Li htin Retrofit �$25 r Fixture t Center Pivot Irri ation Boom �$40 Manufactured Home Park Lots �$2 I he certily that I in the eledrical instellatlon described herein on �he tleres stated: Recreational Vehicle Park Sites �$ i0�"" °"'� S rate Bondin Ins ion �$20 S �al Ins � $30 r Hour �"` "'�1qN °"� S ial Ins ection �$.31 er Mile �'l� THIS lNSTAlLATION MAY BE ORDERED D13CONNECTED IF NOT COMPL TED THIN 18 MONTHS -- - - ---- — -_ -- _ _ FOR OFFICE USE ONLY f � � �� If�� I�� I�� I� �� E 1 D 7 O 6 6 D 4�E Request Date: Rough-in Inspection Required? ❑ Yes 0 No InspecUon Other Than Rough-In: eady Now � Will Call � ` D You must call the inspector when readyl Oate Ready: I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request irtspection of ihe electrical wak at Job Address (Street, Box, or Route No,) / / Ciry _� � Zip Code - _` .�•� �- 0 ��Sf;�� , Electrical Contrector / Campany Name DEPENDABL Mailing A d o � �g?y C�oA Ranie� u�� Phone numonzea signature �con , c:ompany or c�wner rertortni g instaliation) E&00001A•13 7/1/2000 BpARD OF ELECTRIClTY COPY �' .�C 7/ � � � 757-- S� g� � WSTHUCTIONS ON BACK OF YELLOW COPY