P - 82522REQUEST FOR ELECTRICAL INSPECTION
�. �� � � � � e Minnesota Board of Electricity
w � q 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
. (651) 642-0800 TTY/MRS 1-800-627-3529
a�vs=�
www. electricity. state. mn. us
IdentiTy the work covered by this request: ,• �
1L � �' '�'� W 1 i/� ��
❑ NEW ❑ REMODEL DDITION ❑ REPAIR ���
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traific Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li hdn �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service andlor Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING CircuRs and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S stem Device or ratus �$.50 Invest' ative Fee
ADDITIONS FA THE GENERAL FEES Reinspection Fee �$20 __
Retrofit � $25 oer Fixture
HoUf
FOR OFFICE tlSE ONLY
'� IIIIII III�I !II{I 4fill IIII{ II�II IIII! Illl IIII
�E 1 O c 4 6 3 3 8�E
I inspected the
total fee is $20) " U• �
N�l-�t
the da�s smted:
�3 �� �
�� �
I certity t�at I em the �LICENSED
Job Address (Street, Box, or Route No
� c
Section ownship
Oxupant
Power Supp i
! ���
Electrical Conuactor / Company Name
�
Maifing Address (CoMr ctor, Company
1(aU% �I, v��-�.i
CANTRACTOR ❑ COFIVPANY ❑ OWNER and hereby request inspecclion of the electricat work at:
) Ciry T�p Code
.� � ..
• Range Flre
Address
� V "��
�
or Owner Perfortnina Installationl
��� .
Phone
/If..�_ !l�_
, �ompany or c�wner renorming mscauauon� rnone
--- �-- l?�3 � 4� �-�� 9 2_
BOARD OF ELECTAIC�I'Y COPY INSTHUCTONS ON BACK OF YELLOW COPY