P - 80506� REC2UEST FOR ELECTRICAL INSPECTION
1 16 4 0,,, O"� � Minnesota Board of Electricity =�
J� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
/ ,�� ��,��� (651) 642-0800 TTY/MRS 1-500-627-3529
�� www. electricity.state.mn. us
IdentiTy the work covered by this request:
❑NEW REMODEL ❑ADDITION ❑REPAIR �� C �9�1'�� �� r �,Z
GENERAL FEES Outdoor Liahtina Standard �$1
0 to 400 Ampere �
401 to 800 Ampere
Above 800 Ampere
�UITS / FEEDERS
)MMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS OF LESS THAN 50 VOLTS
Each
CeMer Pivot
$50 Per Unit
Und � $25
OTHER AQDC
� $.25 per Fir
�ation Boom �
Sup lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transiormer / Power Su I for Si ns / Oudine Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Suppty up to 500 Amperes, All
Circ�its arid Two Inspection Trips Each DweAi Unit �$B(
Additional Insoection Trios � $20
total fee is
N � - �Y-�,i
�
herebv certifv that I inscected the electrical installation described herein on the dates stated:
Se f2te BOndin I ioll �$20
S ial Ins 'on �$30 r Hour �PCtON DA1E
S 'al In 'on � $.31 r Mile �' �" �
___ THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS �
FOR OFFICE U8E ONLY
l I�Illl 11111 IIIII IIII! Illll Lllll lllll lIILI IIII llll o,�o
�E 1 1 6 4 D i D 9� �"� ��� �
Request Date: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now wll Call
C� You must cafl the inspector when ready! Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER arnl hereby request inspeetion of the elechical work at
Jo6 qddress (Sheet, Bo� or Route No.) Citv r+ . Zip Code
� Mailing
L-
EB•00001A-13
��
Address
�"�i�CT., INC.
RAL AJ�. N.E.
r, ner Perfortning
ractor,�omp�ny of er P r
Phone
OF ELECTRICITY COPY
!I� 7�7�I��' �
-� WSTFiUC'ilON3 ON BACK OF YELLOW C�Y