P - 81732REQUEST FOR ELECTRICAL INSPECTION
11° 0 4 5- 9 6 3 �' Minnesota Board of Electricity "'� �
� r, 1821 U�iversity Avenue Suite S-128, Saint Paul, Minnesota 55104
� � ��� (651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. state. mn. us
IdentiTy the work cavered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION REPAIR �L�S� `-' FI -l��
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES TraHic Si nal Standard �$5
0 to 400 Ampere � $25
401 to 800 Ampere � $50
Above 800 Ampere � $75
�UITS ! FEEDERS
0 to 200 Ampere � $5
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTROL,
�UfTS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Dev+ce or A�naratus �$.50
Additional Unit �
Center Pivot Irriaation Boom �
'�fISp2ClI0f1 � $21
� �0 DEf FiOUf
Su lemental Fee � $20
Transformers u to 10 KVA (� $10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLING5, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit @$8(
Add'Rional Insoection Trios � $20
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fee is $20) � �
herein on the dates stated:
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THIS INSTALL TIO�A/�Y BE ORDERED bISCONNECTED IF NOT COMPLETEQ WITHIN 18 MONTH$ '
FOR OFFICE USE ONLY
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Request Date: � Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: Ready Now ❑ Will Calt
-� �' O You must call the inspector when ready! Date Ready:
I ce�iiy that 1 am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the eleclrica{ work at:
Job Address (Street x, or Route No.) Zip Cod�
^y-"� (� �c.r; D�Y.� , ...
Se 'on � oWnship Range rre o. County
2869
Occupan �0�8
� IzU S-c�._ 1�� --- � � �
Address
License
Pdfly Of VW�16f YBRORnIng n�s�aiwu�n�/
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Compa�y or Owner PeAorming Installation)
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BOAfiU OF ELECTFtICR`( COPY
License
ON BACK OF YELLdW COPY