P - 79789REQUEST FOR ELECTRICAL INSPECTION
1���.� - 9 4 6 ��0 '� Minnesota Board of Electriciry
`" 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�
m�w� � (651) 642-0800 TTY/MRS 1-800-627-3529
iwww.electricity.state.mn.us ' �i��, '�'
Identify the wotk covered by this reques �,� �
❑NEW ❑REMODEL ❑ADDITION REPAIR I l 1G C.-�- ��K.'V`� �"�
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee (� $20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transfortners over 10 KVA �$20
CUITS I FEEDERS Transformer I Power Su I for Si ns / OuGine Li Min �$5
0 to 200 Ampere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin UnR �$80
nan qTS CIRCUITS OF LESS THAN 50 VOLTS Additional Inscection Trips �$20
ich System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL F
FAMILY DWELLINGS (PER UNI�
to 12 Units �$50 Per Unit
OTHER ADDITIONAL FEES
Retrofit � $25 per Fixture
�ivot Irtiaation Boom � $40
Fee
total fee is
herein ai the
S rate Bondin Ins ection �$!0� V v V
S ecial Ins ion �$30 er Hour `""`"'�"`"0N //q w�
C......i�l I.......�Mlnn GT @ Rt nnr \Ailn / ` �Z � �
FOR OFFICE USE ONLY
I Ilfill �Illi IIIII IIIII Illil IIIII III#I II{II IIII IIII
� 1 3 7 3 9 4 6 1�E
,���Gj�� �� �����b
�
I certiiy that I am th�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and he►eby request inspection of the electrical work at
�A�r� {$tree Box, or R� No.) City �-.+ -� Lp�c`�r\-' 1`-/�
� i u � DY ��r � �
�
Section Township Range Fire No. Cou
. �C� a�i �- ('�(��L�,
�51�
Owner Performing
-�c� r
iv or Owner Perfor
�1
7/1/2000
Phone
`�t�3 �4 �S CS`� �3
fi��-rl f� ��'���oa�
rador License Number ster License Number
7 i 1�� � �
� �� v� �.. ��� �
i�y .�....�...� . y �� J V ��� 4' ` t
BOARD OF ELECTRICITY COPY INSTRUCTONS ON BACK OF YELLOW COPY