P - 80006� REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1-396-119 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OS00 TTY/MRS 1-800-627-3529
www.e%ctricity.state.mn.us '
Ider�ify the work covered by this request:
0"NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
0
ALARM, COMMUNICATION, REMO7E CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A paratus �$.50
ADDITIONS TO THF GENERAL FEES
MULTIFAMILY DWELLINGS (PER UN
3 to 12 Units �$50 Per Unit
Each Additional Unit � �25
Cerder Pivnt Irrigatio� Ba
Manufactured Home Park
Recreational Vehicle Park
Separate Bonding InspecG
Soecial InsoecNon � �30
?tCEL ENERQY SAVER'S SWITCH
i ransrormers over iu Kv,v ��zu
Transformers / Power Supply for Signs / Outline Lighting �$!
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unft �$80
Additionat Inspection Trips � $20
InvestigaGve Fee
� Reinspection Fee � $20
fee is
me elei.irica+ ins+aNaSrn, aescriued ne.ein oo ure ae�es smtea:
ROUGH IN
FINAL INSPECTION /�'�
�
�NECTED IF NOT COMPLETED �
FOR OFFICE USE ONLY
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Reque��ro2 Rough-in Inspection Required? ❑ Yes IRNo Inspection Other Than Rough-in: �Ready Now ❑ Will Call
You must call the inspector when ready! Date Ready:
I certity that I am the [� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address{StrqWj, Box.q�FJqytQyq,� City FR��,, Zfp Code �e�
6C63 / 1 hf b I NC
Section Township Range Fire No. Counry A(�(A
Occ� W�N E � 1'� Phone
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Power Su_p�lier_ �Y Address
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Electrica► �o�]t�tpt,/ �y11���TI� Contractor Licw,c�,e �y�gp,¢� Master License Number
f"I111V I t,l.tG I I+tl(� SN�1 [)t)R�G
Mailing �1 1 tKK1��yHUI� � Pb�`�����°�AN 55114
Authorize ' ature (�rector, ompany or Owner PeAOrtning Instailation) Phone �1 ����,
E6-�0001A-13 711(2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY