P - 79511REQUEST FOR ELECTRICAL INSPECTION
�° 2 8 2� 6 O 5 m� Minnesota Board of Electricity
�, 1821 Universiiy Avenue Suite S-128, Saint Paul, Minnesota 55104
;� ��� (651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. state. mn. us
Identify the work covered by this request:
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❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR G��� � / � +
GENERAL FEES Outdoor Li hh Standard �$1
SERVICES 1 POWER SUPPLIES Traffic Si nat Standard �$5
0 to 400 Am ere �$25
401 to 800 Am ere (� $50
Above 800 Am ere � $75
CtRCUITS / FEEDERS
0 to 200 Am re �$5
Above 200 Am ere � $10
ALARM, COMMUNlGAT10N, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Addftional Unft � $25
OTHER ADDITIONAL FEES
0
RecreaGonal Vehicle Park Sites �
Su lemental Fee � $20
Transformers u to 1� KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I tor Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, AII
Circuits and Two Inspection Trips Each Dwellin Unii �$8t
Additional Inscection Trios � $20
Fee �
total fee is
that I inspected the e�ectrical installation described herein an the daTes
FOR OFFICE USE ONLY
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Reque ate: Rough-in Inspection Required? ❑ Yes Inspection Other Than I
You must call the inspector when ready! Date Ready:
I certify that I am th�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and here y
Job Add� ress IStreet.� x. or,Route No.l l.l � Ciri r.— •.
Range
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Electric ntractor / Company Name
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Mailing Address (Cont or, Com ny o Owner Perh
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Authorized S'�gnatu (Contract , ompanybr Owner
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. EB-OOOOtA-13 7/1/2000
County
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BOARD OF ELECTHICITY COPY
WITHIN 18 MONTHS
2# �a���� �
inspection of the electrical work at:
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INS7AUCTION3 ON BACK OF YELLOW COPY