P - 819441-�C69-710 �.;�F
Identity the wbrk covered by this request:
❑ NEW 1�REMODEL ❑ ADDITION ❑ REPAIR
0 to 400 Am re �
401 to 800 Am ere
Above 800 Am ere
CIRCUITS / FEEDERS
REQUEST FOR ELECTRICAL INSPECTION
�,
Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY(MRS 1-800-627-3529
www.electricity.state.mn.us '� "
CIRCUI7S, 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
OTHER ADDITIONAL FEES
Retrofit � $25 oer F#ure �
Inspection � $2(
� $30 oer Hour
� � f��n .
Outdoor Li htin Standard � $1
Traffic Si nal Standard � $5
Su lementai Fee � $20
Transtormers u to 10 KVA �$10
Transformers over 10 KVA C� $20
Transformer / Power Su pl for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
3 Circuits and Two Inspection Trips Each Dwellin Unit �$8(
Additional Insoection Trios � $20
Fee (�
FOR OFFlCE tHIE ONLY
'�� llllll �fif� Illll llfll Il11i 1��1 lIIII IIII iIN �� ��� +�
�� o� g� i o r� � ��5d
total fee is
� ��
Ready Now � Will
� (� l p�jj � 0� � You must call fhe inspectar when �eady! � Date Ready: �
Tr
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspec�tion of the electrical work at
Job Address (Street, Box, w Route NoJ City Zip Code
1� i t� e,�2r� � C►'2. �. �'Ri c�4�� �Ss�a/
Section Township Range Fire No. Cou
/ /,���
Occupam� �L°�� ��D�11 c,��`�C.i� �° j� Phone
Power Supplfer Address
Electrical ConVactor / Compan Contractor License Number Maste� Licensa Number
Standard Electric Co., Inc. CA01715
Mailing Addresa (CoMrador, Comparry or Owner Performing Installation)
2672 M p ewood Drive, Maplewood MN 55109
Authorized Sig (Contrector, Com er Perfortning lt�stallation) Phone
2 � 651-484-8044
EB�W W7A- 7/7/2000 BOARD OF ELECTHICITY COPY WSTHUC710N8 ON BACK OP VELLOW COPY