P - 81689Iv\��� ��L�L L �� REQUEST FOR ELECTRICAL INSPECTION
�'0 4 6 � /� Minnesota Board of Electricity �'"'
� � ��e 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
r m (651) 642-0800 TTY/MRS 1-500-627-3529
www.electricity.state.mn.us " '
IdentiTy the work covered by this request C� `
❑NEW ❑REMODEL ❑ADDI710N REPAIR �- kF�
GENERAL FEES Outdoor Li htin Standard �$t
SERVICES / POWER SUPPLIES Traftic Sianal Standard �$5
Above 800 Ampere � $75
�UtTS / FEEQERS
0 to 200 Ampere @ $5
Above 200 Ampere � $10
RM, COMMUNICATiON, REMOTE CONTROL,
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svsteni Device or Aooaratus �$.50
3 to 12 Units �$50 Per
Each Additional Unit � $
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 DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up io 500 Amperes, All
Circuits and 7wo Inspection Trips Each Dwellin Unit �$8(
Additional Ins ection Tri s�$20
Investi ative Fee
Reinsoection Fee � $ZO
total fee is
� �� c�_�y —o(
that I inscecled the electrical installatian tlescribed
Recreationai Vehide Park Sftes � $5 '" """
Se rate Bondin Ins ection �$20
S ecial Ins ection �$30 er Hour °"'�
' I In 'on � $.31 er Mi�e � � �-3 G3
__ T1il�JNSTALLATlOd_MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WlTiil�t 18 MQMTJ3�— —
FOR OFFICE USE ONLY
�«1��� il��i ����� ii��� ��ii� ����i���i ii�i i��� �� �3 �- s
� � Q 4 6� 3��� ao, so ��-.
Reque Date: Rough-in Inspec0ion Required? ❑.Yes ❑ No Inspeciion Olher Than Rough-In: ❑ Ready Now � Will Call
� l�+'`O � You must call the inspector when ready! Date Ready:
I certify that I am the��LICENSED CONTRACTOR ❑ COMPANY ❑ OWNEH and hereby request inspection of the elecUical work at
Job Address (Street_Box, or Route NoJ _ _ City n,. ,� _ Zip Code ��
Section Township
��
u��� ��
Power Supplier �
�-'7
ctrical Contra or / Compa I
c
�
Mailina Address (Contracto . CompanY or Owner
Fire (�o. CoUity
J �� �
8 Phone ,� �� ` �
' �lJ
� s �d�� ��,
Contractor_License Number MBSter Lir�r
� t�17� �` '�
" 1' `� I�!, /� ) c1 D V V- i
BOAHD OF ELECTRICT' COPY � IN3TRUC71UN8 ON BACK OF YELLOW COPV