P - 81544REQUEST FOR ELECTRICALINSPECTION
Y���0 3 9 6 8 0 � a Minnesota Board of Electricity
W� e �°'�� i821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electri city. state. mn. us
Identity the work covered by this request:
❑ NEW REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Lighting Standard �$1
SERVICES / POWER SUPPLIES
0 to 400 Am ere �$25
401 to 800 Am ere �$50
Above 800 Am re � $75
CIRCUITS / FEEDERS
0 to 200 Am re l� $5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REM!
CIRCUITS, CIRCUITS OF LESS T
Each S stem Device or ar
ADDITIONS TO T
MULTIFAMILY DWELLINGS PER
3 to 12 Units �$50 Per Unft
I Retrofd � $.25 per Fi#u
Pivot Irrigation Boom � $
ctured Home Park Lots �
�
Standard �
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li hlin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 500 Amperes, All
CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$S(
50 VOLTS Additional Ins ction Tri s�$20
� $.50 Investigative Fee _
(minimum total fee is
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Request Date: Rough-in Inspection Required? ❑ Yes o Inspectian Other Than Rough-In: ❑ Ready Now Will Call
'� .• You must call the inspector when readyl Date Ready:
I certify that I am the�LICENSED CANTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route NoJ City Zp Code
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Electrical Cor� or / Company Name Conhactor License Number Master License Number
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Mailing Address (CoMractor, Company or Owner Perfortning Installatlon)
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7/1l2000 . 60AHD OF ELECTRICRY COPY. INSTAUC710NS ON BACK OF YELLOW COPY