P - 81599REQUEST FOR ELECTRICAL INSPECTION;
° Minnesota Board of Electricity � °`
1�� 4, �'� g 2 3 ; 1921 University Avenue Suite S-128, Saint Paul, Minnesota 55104 .
' ez� �a� (651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity.state.mrt. us
Identify the work covered by this request: . � r,
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❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin andard �$1
SERVICES I POWER SUPPLIES Traific Si nal Standard �$5
0 to 400 Am ere �$25 Sup lemental Fee (� $20
401 to 800 Am ere (� $50 Transformers u to 10 KVA �$10
Above S00 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer ! Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two inspection Trips Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF IESS THAN 50 VOLTS Additional Ins ection Tri s�$20
Each Svstem Device or Aooaratus �$.50 Investigative Fee
MULTIFAMILY DWELLINGS (PER UNI�
,, 8 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL
LidtlBtm Retrofd � $.25 oer Fi�Rure
I Home Park Lots � 9
Vehi�e Park Sites
uling Inspection �
rction � $30 per Hour
:ction � $.31 oer Mile
(minimum total fee is $20 .
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thffi I inspected the electriql installalion descnbed herein on tl�e dates slated:
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FOR OFRCE USE ONLY
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I cerGiy that i am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, w Route No.) j City Zip Code
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Sec[ion Township Range Fire No. Counry ,
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Occupant a � rnone
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Power Supplier � dress
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Ele cal CoM ctor / Company Name ,� ntractor License Number
�Y'C'._.�f`� �[G�6 Y'l 4_ y� � Da � �
Mailin� dd� (� trec[or, C�ar�y or Ow�r Performing Ins Ilation) � �
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Authorized Si natu e(Co mpan or Owner Perfortning Installation) I
EB-0OOOtA-1 �/1l2000 BOARD OF ELECTAICITY COPY
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f ON BACK OF YELLOW COPY