P - 80060. REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
, 1-396-098 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. sta te. mn. us
Identity the work covered by this request:
O�NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR X�EL ENERQY SAVER�S SW ITCH
to 400
11 to S
�ove S
ITS / f
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50 -�
ADDITIONS TO THG GENERAL FEES
MULTIFAMILV DWELLINGS (PER UNI�
3 to 12 Units �$50 Per Unit
�rigation Boom �
Home Park Lots
� $30 aer Fbur
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transfortners / Power Su I for Si ns / Outline Li h6n �
ONE & 1W0 FAMILY DWELLINGS, EACH UN�T
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unft �$F
Additional Inspection Trips � $20
FOR MSPECTOF USE ONLV
I hereby certity that I
RWGH IN
FIW1L INSPECTION
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��e
� $20
TOTAL FEE
(minimum total fee is $20)
Yetl Me electricelinstallation tlascribed herein on Me detes slated'.
DATE
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FOR OFFlCE USE ONLY
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Reque��/Q"1 Rough-in Inspection Required? ❑ Yes [�,No Inspection Other Than Rough-in: �Feady Now ❑ Will Call
You must call the inspector when ready! Date Ready:
I certify that I am the L� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
E&OOOOIA-13 7/1/2000 BOARD OF ELECTRICITY COPY IN51 HUI:I IVN, Vrv esHCn vr rc�wvv wrr