P - 80520REQUEST 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.electncaty.state.mn.us " '
Identity the work covered by this request: �� � ^ C e�� C�, _
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❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Ouidoor Li htin Standard �$1
SERVICFS i_POWER SUPPLiES �"7 __. Traffic Signal Standard �$5
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus f� $.50
Iditlonal Unit � $25
OTHER ADDITIONAL FEES
Retrofit (� S25 uer Fixture
Park Sites �
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$30 oer Hour
Su lemental Fee � $20
Transformers up to 10 KVA (� $10
Trenstormers over 10 KVA � $20
Transformer / Power Su for Si ns / Oudine Li hti �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Inciudes the Service andlor Power Suppiy up to 500 Amperes, All
Circuits and Two Inspec6on Trips Each Dwellin Unit �$80
Additional Ins ection Tri s�$2U
Investi ative Fee
Reinsoection Fee � S20
total fee is
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described herein an the deies sfated:
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FOR OFFICE USE ONLY
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Request Date: � Rough-in InspecUon Required? ❑ Ye's ❑ No Inspection Other Than Rough-In: ❑�Ready Now �❑ �II Call
� �� You must call the inspector when ready! Date Ready:
i ce dy that I am the J�LICENSED CONTRACTOR ❑ COMPANY ❑ OWN e uest inspecction of the electrical work at
Job Address (Street, Box, or Route No.) ip Cod�
7��5 � . l�i U�f � � /" .�1� � f�3a
Sectlon Township (]_J ange Fire Cou
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Electrical Contrector /
Mailing Address Con
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Authorized Si ature
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EB-OOOOtA-13 7/1/2000
Phone
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BOARD OF ELECTRICRY COPY .. ._.._. __. . MISTRUCTIONS-0N BACK OF YEI. t nu� ^^"'