Fillable Submit a separate application for each structure per (North Dakota State Electrical Board)

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Submit a separate application for each structure per (North Dakota State Electrical Board)

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• Submit a separate application for each structure per ND Laws, Rules & Wiring Standards
24.1-05-01-02 (5)(e).
• Inspection fee is based on the job cost for electrical labor and material. Fee calculator is available on
our website at www.ndseb.com, Inspections, Inspection Fees and must accompany this application.
• Describe and list equipment on page 2 of this application.
EQUIPMENT INFORMATION
Equipment and Wiring Designed to be used as
Identification/Serial Number
Manufacturer Date
ND Shipment Arrival Date
OWNER INFORMATION
Owner Name
Address
City
State
ZIP Code
Contact Person
Office Telephone Number
Cell Phone Number
LOCATION OF STRUCTURE – ADDRESS OR LEGAL DESCRIPTION
Address
City
State
Township
Section
Quarter
Well Name (Not Pad Name)
ND County
JOB COST AND INSPECTION FEE
Job Cost
Inspection Fee
MANUFACTURER INFORMATION
Manufacturer
Address
City
State
ZIP Code
Contact Person
Office Telephone Number
Cell Phone Number
FOR OFFICE USE ONLY
ND State Electrical Board Assigned Certificate Number
APPLICATION FOR OUT OF STATE STRUCTURES OR SKIDS
NORTH DAKOTA STATE ELECTRICAL BOARD
SFN 61923 (12-2020)
SFN 61923 (12-2020)
Page 2 of 2
• Describe and list in detail the electrical equipment and wiring done (example: voltage, amperage,
quantity of starters, panels, motor control center (MCC), motors horsepower (HP), quantity of lights,
devices or other electrical apparatus, area classification). Please be specific if it is designed for a
hazardous location with Class and Division. For additional information, use a separate sheet.
Description
Main Service
☐ No ☐ Yes
Class
Division
Structure Square Feet
Item
Quantity
Voltage
Amperage
Phase
Size
Type
Main Service
Motor Control Center
Other Control Panel
Panel - A
Panel - B
Starter/Variable Frequency
Drive (VFD) – A
Starter/Variable Frequency
Drive (VFD) – B
Motor – Type A
Motor – Type B
Lights – Type A
Lights – Type B
Receptacles – Type A
Receptacles – Type B
Submit completed application to:
North Dakota State Electrical Board Phone: 701-328-9522
PO Box 7335 Fax: 701-328-9524
Bismarck, ND 58507 Email address: electric@nd.gov
Website: www.ndseb.com
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Completed 21 April 2021

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