P - 80160REQUEST FOR ELECTRICAL INSPECTION
1 31 � 3 3 O e� Minnesota Board of Electricity -
� � "?� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� �e.,se (651) 642-0800 TTY/MRS 1-800-627-3529
� www.electricity.state.mn.us " '
Identify the work covered by this request: ��� � p �" ��C o v�� C�/, 5 I - j. r fG s Q'%� Ga r ac� E
❑ NEW ❑ REMODEL ❑ ADDITION EPAIR a h-�„ y i /� �/ �� 1 4`� L
GENERAL FEES utdoor Lighting Standard �$1
0 to 400 Ampere
401 to 800 Ampe
Above 8� Amper
CUITSJ FEEDER:
0 to 200 Ampere
Above 200 Ampere � $10
JICATION, REMOTE CONTROL, SIGI
IITS OF LESS THAN 50 VOLTS
Device or Appazatus � $.50
DDITIONS TO THE GENERAL FEES
�$
re �
MULTIFA
3 to
Each
Retroffi � $25 per Fixture
'ivot Irriga6on Boom � $4(
tured Home Park Lots � �
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Supply for Siqns ! Outline LigMing �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
lncludes the Service and(or Pawer Suppty up to 50U Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$8(
Additional Ins ection Tri s�$20
Irnesti ative Fee
Reinsoection Fee � $20
that I insoected the electrical
S ial Ins 'on �$30 r Hour - " """°""'""" �
Special Inspection � $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF
FOR OFFICE USE ONLY
! llllll illll �Illl Illii 11111 lilll I�I1I Illll Ill! IIII
�E 1 3 1 2 3 3 O Z�E
l;equest Date: Rough-in Inspection Required? ❑ Yes � Inspec
O- 2(��� °� You must call the inspector when ready! Date I
I certi(y that I am the �fCENSED CONTRACTOR ❑ COMPANY ❑ OWNER
total fee is $20) o��
xribed herein on tl� � stated:
wh
�r wh
�-- ff'� C� L�
�ITHIN 18 MONTHS
�' ��`
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3r Than Rouah-In: dv Now ❑�II CaN
and hereby request inspection of the electrical work at: