P - 80086REQUEST FOR ELECTRICAL INSPECTION
Q1 � $ - Minnesota Board of Electricity —
�� 2 6 8� V 1� ��� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
,�� aa. (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us " '
Identify the work covered by this request: �� ��
❑ NEW ❑ REMODEL ❑ ADDITION REPAIR
GENERAL ES Outdoor Li htin Standard �$t
SERVICES / POWER SUPPLIES Traific 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 S00 Am re (� $75 Transformers over 10 KVA �$20
IRCUITS I FEEDERS Transformer I Power S for S' I Outlir�e Li ti �$5
0 to 200 Am re �$5 NE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service and/or Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional In ion Tri s�$20
Each S stem Device or A aratus �$.50 tnvesti ative Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$5o Per unit (minimum total fee is $20
Each Additional Unft �$25 FOF INSPEGTOfl USE ONLV
OTHER ADDIT{ONAL FEES �+. S
Liahtina Retrofit (� $25 oer Fixture
installatan described herein an
S ial In ion �$30 er Hour "�'"''""'� //
Special Inspectlon �$ 31 per Mile ` — �d— Z�
� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONIY
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3E 1 6 S 8 1 6 4�E �$" �
Request $i�, Rough-in Inspection Required7 � ❑ Yes No Inspection Other Than Rough-In: Ready Now 0 WiA Call
W O� You must call the inspector when ready! Date Ready:
I ce' that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Address (Street, Box, o.) City �P C�
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Section Township Range Fire No. Count� �
tractor / Company
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EB-OOOOtA-13 7/1/2000
Phone
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CoM ctor License Number Master License Number
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or Owner Perfomi g Installation)
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�an er Performing Installatlon) Phone
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BOAFiD OF ELECTRICITY COPY � INSTRUCTIONS ON BACK Of YELLOW COPY