P - 81797REQUEST FOR ELECTRICAL INSPECTION
1 � � � 7 - � � �+ „ Minnesota Board of Electricity �
b 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
• (651) 642-0800 TTY/MRS 1-500-627-3529
www.electricity.state.mn.us
Identify the work covered by this request:
❑ NEW EMODEL ❑ ADDITION � REPAIR � ��` �2 ` "
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Sianal Standard �$5
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REI
CIRCUITS, CIRCUITS OF LESS
Each Svstem Device or App
50 VOL'
� $.50
OTHER ADDITIONAL FEES
Manufactured Home Park Lots �
Recreational Vehicle Park Sites �
Transformers over 10 KVA (� $20
Transformer / Power Supply for Signs / Outline Lighting �$5
ONE & TWO FAMILY DWELLIN�S, EACH UNIT
Includes the Service and�or Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$Bf
Additional Ins ection Tri s�$20
Investl ative Fee
Reinsoection Fee � $20
I herebvi cerMv that I
total fee is
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>pecial Inspection � $.31 per Mile S"
THIS INSTALLATtON MAY BE ORDERED DISCONNECTED IF COMPLETED WiTHtN 18 MONTH
FOR OFRCE U8E ONLY
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I Request Date: I Rough-in Inspection Required? ❑ Yes �No I Inspection Otlier Than Rough-In: ❑ Ready Now �9Yi11 Call I
��ZT rb � You must call the inspector when readyl Date Ready: �
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, ox, or R e No.) City Zip Code
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Section Township Range Fire No. CouMy �
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Phone
Electrical Contra or / Company Namg Contractor License Number Master License Number
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Mailing Address (ConVactor, Company or Owner Performing Installation)
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Authori ignat pany or Own P orming Installation) Phone
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E&00001A-13 7I1Y2000
BOARD OF ELECTfi1CITY COPY � WS7RUCTIONS ON BACK OF Y@LLOW COPY