P - 81896REQUEST FOR ELECTRICAL INSPECTION
� 12 4 4 8 4 Minnesota Board of Electricity ��
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� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800- 7-3529
www.electricity. state.mn. u
IdentiTy the work covered Dy this request: ��
❑NEW ❑REMODEL ❑ADDITION ❑RE IR / 1 `� o% J�`�
GENERAL FEES Out oor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lementai Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transfortner / 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 re �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$SO
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins an Tri s�$20
Each stem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinsoection Fee �$20
TIFAMILY DWELLINGS (PER UNI�
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Manufactured Home Park Lots �$25 I hen
Recreational VehiGe Padc Siles � $5 � "�'
Seoarate Bondina Insoection � S20
total fee is
on tlie dams a�ed:
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFlCE USE ONLY
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Requ Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: Ready Now ❑�11 Call �
�� ' Q You must call the inspector when readyl Date Ready: � � �
I ceRi(y that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER arni hereby request inspection of the electrical work at:
,I� Address (Street, Box, or Route N City Zip Code
.31 ' s`7 � �—,�� �s`��.3�-
Section Township � r Fire No. County
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Phone
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E� DEPENf�ABL�e�LECTRIC. INC COntractor License Number Master License Numbe
Mai • � orming Insta�lation)
Caon 4pids. MN 55433
Authorized Signa Mrador, Company or Owner P rming Instellation) Phone
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E&OOOOIA-13 7/1 BOApD OF ELEC7AICITII COPY ON BACK OF VELLOW COPY