P - 78517REGIUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
�'�'3 4`7 � 3 7 6 `� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 _
www.electricity.state.mn.us
Identify the work covered by this request: /` �� ����
EW ❑REMODEL ❑ADDITION ❑REPAIR �Q'�{'F
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Tra(fic Si nal Standard �$5
�
Above 800
Above 200 Ampere (� $10
RM, COMMUNICATION, REMOTE CONTROL, SIGI
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
_TIFAMILY DWELLINGS (PER UNI�
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
I inMir�a Retrofit � S25 cer Fixture
Vehide
Fee � $20
i� to 10 KVA �
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$8(
Fee �
linspectedthe electrical
total fee is
� � Special Inspeclion �$30 per Hour I I"'"' -� �" u
r� Cncnal Inenar}inn 4H Q 31 �8f �I�B � � � ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN.i�@'MONTHS
—�-. — .—__---__------
� � � ��r ��'�� ���5��
IIIIIiIfIIIIiIIIIifIIIlliCllli}III111fIIIIIIIIN � /��
ll �
� 1 3 4 7 3 7 6 4� ��i L�� (�(�� c�
Re�jquest Date: Rough-in Inspection Required? Yes ❑ No Inspeclion Other Than RougMln: ❑ Ready Now iil Call
7� f 9/�� You must call the inspector when readyl Date Ready:
I certity that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY �WNER and hereby request inspection of the elecfical work at:
EB-OOOOtA-13 7/1@000 � BOARD OF El.eci�i�crrr cvrT �a� ••�••° ^^.—. .----- --� -
__ -���_ — —