P - 80104REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity -
���� 8� 2 0 8 v 1821 University Avenue Suite - , aint Paul, Minnesota 55104
` ` A � °� (651) 642-0800 TTY/M 1 �0�0.-��529
www.electricitv.sta e.mr,�u] � ' '
Identity the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDiTION ❑ REPAIR
0 to 4� Ampere 8$25
401 to 800 Ampere � $50
Above S00 Ampere � $75
CUITS / FEEDERS
0 to 200 Ampere � $5
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTROL, SIGI
CUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or ApQaratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTiFAMfLY DWELLING:
3 to 12 Unfts �$50 P
Each Additional Unit �
OTHE
Liahtina Retrofit � $2;
�m � $4
Lots �
Sites �
FEES
/Y ' � - G�i�L
Oub oor Li htin Standard �$1
Traffic Si nal Standard � $5
Su emental Fee � $20
Transformers u to 10 KVA (� $10
Trans(ormers over 10 KVA � $20
Transformer / Power Su I for Si ns / OuUine Li htln �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
fncludes the Service andlor Power Supply up to 500 Amperes, Atl
Circuits and Two Inspection Trips Each Dwelling Unit �$8(
Reins ection Fee � $20
TOTAL FEE
(minimum total fee is $
PoF INSPECTOR USE ONLV /�
V•:
I herebv certifv Nat I inspected the electrical installation described herein on the dates stated:
S ecial In ection �$.31 er Mile —
THIS INSTALLATION MAY BE ORDERED DISCONNECTE T COMPLETED WITHI�
a FOR OFFICE USE ONLY
� ����I� 1���� ��I�� ��1�� Il��l ����� �I��! I�111 l��� ���� �J ���
� 1 3 3 6 2 O B O� /C�"
0
� � ' '
Request Date: Aough-in Inspection Fequired? ❑ Yes ❑ No Inspection Other Than Rough-In: �e Cy Now V ww can I
� �G�� ,� �
You must call the inspector when ready! Date Ready:
I certity that I am tl�'CICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspeclion of the electrical wak at