P - 80512REQUEST FOR ELECTRICAL INSPECTION
> Minnesota Board of Electricity
1� 14 3-12 5 '� 182� Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
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Identity the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION �EPAIR
GENERAL FEES Outdoor Li htin Standard �$t
S VICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 400 Am ere �$25 e'p Su lemental Fee �$20
401 to S00 Amoere �$50 Transfortners u to 10 KVA �$10
CIRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL f
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
Retrofit � $25 oer Fixlure
Transfortners over 10 KVA � $20
Transformer / Power Su for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$8(
Additional Ins ection Tri s�$20
Investi ative Fee
Reinsoection Fee � $20
that I insoected the
total fee is
S ecial Ins ection �$30 r Fbur """""'`�""" � ����6 � I
Special Inspection � $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF I�ST COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Req est Da : Rough-in Inspeclion Required? ❑ Yes o Inspection Other Than Aough-In: ❑ Ready wll Call
— 1 You must call the inspector when readyl Date Ready:
I ce�tity that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request in�ection of the elechical work at
Job Address (Street, Box, or Route No.) City f�� Zfp Code
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Section Township Range Fire No. County �
Occupant
Power Supplier
E rical CoMractor / Company Name
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ailing Address (Cor�trador, Company or
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Address
Company o�ner Performing
License Number
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7/1/2000 BOAAD OF ELECTAICRY COPY INSTFIUCTIONS ON BACK OF YELLOW COPY