P - 82025REG�UEST FOR ELECTRICAL INSPECTION
� Minnesota Board of Electricity �""
�� � 3����� � 1821 University Avenue Suite S-128, SainY Paul, Minnesota 55104
� (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us " '`
Identity the work covered by this request: ,��� � � �
/
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR � G
GENERAL FEES door Li h tandard �$1
SERVICES / POWER SUPPLIES Traffic Si nal dard �$5
9 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere c� $50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
RCUITS 1 FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional ins ction 7ri s�$20
Each S stem Device or A aratus (� $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinsoection Fee (� $20
(minimum total fee is
�8���
Retrofit � $25 per Fixture
'ivot Irriaation Boom (� $4(
i herebvi ceAifv that I insuected the electrical
�
, •�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED_WITNIN 7_8 MvNTMS ,_
FOR OFFICE USE ONLY
�'� �`� g g t�
I 11111! l�l�l l�lli Illl� 1III11�� 1t�111t11 I11i �� �
� 1 1 3 O 6 7 Q 1�E �r�
R st ate: Fough-in Inspectlon Fiequired? ❑ Yes Na tnspection Other Than Rough-In: ❑ Ready Now Wil{ Call
Vou must call the inspector when ready! Date Ready:
I certi[y that l am the �LICENSED CANTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the eiectrical work at:
Job A�ss (�treet, Box,, or R ut � _ A� C' ��jJ/�� /f ZP ��
I� 1 �� !r1�r��
Na.
Phone
or bwner Peq�llninp Installation) � Phone
f l0� .1>I�S"/i`v L
BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY