P - 82010REQUEST FOR ELECTRICAL INSPECTION
e;�$ Minnesota Board of Electricity —
�.L - 0 91 �� 1 V='�� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 7-800-627-3529
www.electriciry.state.rrcn.us '' '
Identity the work covered by this request: z�gg,qL` �} Gyp�{,N�(S �Z �� I, �h(,N ��(J�1. ,
❑NEW �REMODEL ❑ADDITION ❑REPAIR �� �� �a�"�Oj"''4vi� <<) D��S��S/�� C�� D�t}t+�+ffH�
GENERAL FEES Out oor i htin S n a $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Sup 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 Trar�sformer I Power S I ior Si ns i Outline Li Min �$5
0 to 200 Am ere �$5 � ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTR��, SIGNAIING Gircuits and Two Inspection Trips Each Dwell+ UnR �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20
Each S stem Device or Ap aratus d$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinsoection Fee �$20
OTHER ADDITI01
Retroiit � $25 oer Fixture
totaf fee is
LL�f =�•.
I hereW ceRifV that I inspected the elec]p�y installafion described here(n on the dates
i � Special Inspection �$30 per Hour _ L_ _J F°'""�"01 .� T `
Speciat Inspection � $.31 per Mile � � � �j � � _
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
Ill����lll�fllll�llllll�flllll�lfflllllllll� �����9�%� �
3E S O 9 1 c 7 B O�4 �i/ /'�`-'
Request Date: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now Wfll Call
"��a _�` You must call the inspector when readyl Date Ready:
1 certify that I am the �UCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electricaf work at
E&00001A•13 7/1/2000 BOARD OF ELECTRICITY COPV INSTHUCTIONS ON BACK OF YELLOW COPY