P - 79593REQUEST FOR ELECTRICAL INSPECTION
ee ��: Minnesota Board of Electricity -`�
1- 216 - 2 2 3 ,�p 9a m 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 6A2-0800 Tl'Y/MRS 1-800-627-3529
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www.electricity.state.mn.us
Identity the work covered by this request: x,' �'Y G .�, �
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NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
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 re �$75 Transtormers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer I Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power 5upply 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 Ins ction Tri s�$20
Each S tem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO 7HE GENERAL FEES Reinspection Fee �$20
to 12 Units �$50 Per Unit
ich Addftional Unit � $25
OTHER ADDITIOP
ahtina Retrofit � $25 cer Fixture
Manufactured
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fee is $201 �."� d �
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18 MONTHS
�R OFPICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: Ready Now Q WIII Calt
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I certity that I am tl�e ["LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecUon of the electrical work aC
Job Address (Street, Box, or oute No.) City Zip Code
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Section Township Range Fire No. Coun �/
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Power Supplier Address 1
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nadress
7/7/2000
my Name C ra or License Nur
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Company or Owner Performing Installatian)
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c[or, m n wner Performing Installatlon)
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