P - 80149RE�UEST FOR ELE�TRICkL WSPECTION
1 � � � � � � � � Minnesota Board of Electricity "
� � g'�� 1821 Univers+ty Avenue Suite S-128, Saint Paul, Minnesota 55104
< m�" � "� (651) 642-0800 TTY/MRS 1-800-627-3529
2 www. lectricity.state.mn.us �
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Identify the w k covered by this request:
❑ NEW EMODEL ❑ ADDITION ❑ REPAIR 1 d� ►✓ ������ "� � � — � � �' ` v � �
GENERAL FEES Outdoor Li htin Standard �$1
ERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su 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
IRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
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, Ail
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit � S80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S tem Device or aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee �$20
MULTIFAMILY DWELLINGS PER UN TOTAL FEE i7
3 to 12 Units �$50 Per Unit (minimum total fee is $20) ls
E2Ch Additi0nal U�it �$25 wa x�saECroa usE owiv
t hereW ceAiN thffi I insoected itre electrical irstallalion
Recreatlonal Vehicle Park Sites �
{ { Special Inspection �$.31 per MMile I I \
_ THIS INSTALLATION MAY BE ORDERED DISCONNECTE
FOR OFFICE USE ONLY
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I certfij that I am the � LICENSED CONTRAGTOR ❑ COMPANY ❑ OWNER and hereby request inspeetiion of tfie electrical wodc at:
Job Address (Stree Box, or u[e No.) City _ Zp�W —1 +�
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Sectio Township nge Fire No. County �
Occupan
vid
Power Supplier
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Electrical Co ct r
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1356?. C�RITr�AL A
Mailing Addresy�{ ,
Authorized/ ture ( t Com�
EB-0OOO1A-13 7/1/20W
Phone
., "R."G.
N.E.
er Pertorming Installation)
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OF ELECTRICRY COPY
License
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IN37AUCTION3 ON BACK OF YELLOW COPY