P - 81804r REQUEST FOR ELECTRICAL INSPECTION
r � Minnesota Board of Electricity '
<�. � 0 61- 7 6 5 =�� Y821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� � � : (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity,state.mn.us '��'
Identify the work covered by this request:
❑ NEW EMODEL ❑ ADDITION ❑ REPAIR � N� � I �? I
GENERAL FEES Outdoor Li tln Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEED€RS Transformer I Power Su I for Si ns ! OuUine Li htin �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Supply up to 500 Amperes, Atl
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$SO
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri �$20
Each S tem Device or A aratus �$.50 Investioabve Fee
ADDITIONS TO THE GENERAL FEES
FAMILY DWELLINGS PER UNI
to 12 Units �$50 Per Unit
�ch Additional Unit � $25
OTHER ADDITIONAL FEES
total fee is
I herebvi cerNfv Mat I inspected the ek�ctrical installaGon tlescribed herein on the
Recreational Vehicle Park Sites �$5 �/ `�1°"" " �+ /� w"
Se rate Bondin Ins 'on �$20 %�-�-- !s� G{ —d
S ecial Ins ion �$30 er Hour `*""'�"01 . �S- °"'�
S ial Ins ection �$.31 er Mile ^ 20 `�
THIS INSTALLIiTION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFlCE USE ONLY
IlI1IIIIIIIt��IIIIIIII�lllll�lllllllllllllll �� a�,� ,�
� .� oss �6sz � i�`�v
Re Date: Rough-in Inspection Required? es ❑ No Inspection Other Than Rough-In: ❑ Ready Now Nf Call
1 Yau must call Nre inspector when reatlyt Daie Ready:
I certity that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER arM hereby request +nspection af the electrical work a1:
Job Address St t, Box, or�No.) �� �� � Z�p� ��
G�
. i 5�,�
Section T Range Fire No. Co ty
r�}
r� , ._.�. . °t' h ,�„ r ,J c� ,. ,.. P�i � _ � _ �� � _ 4 -Z� 2
� Mailing
/ Company Name �
Mracto�
e
��.,�`����.�,.
� �i 1 11�l�J 5�
� Phone
- --g�f g
COPY INS'TRUCTpNS ON BACK OF YELLOW COPY