P - 80500` REGIUEST FOR ELECTRICAL INSPECTION
/� Minnesota Board of Electricity —
����`t - 015 �;r� �82� University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
` ,��O�C�� www.electricity.state.mn.us '� '
Identity the work covered by this request:
❑NEW EMODEL ❑ADDITION ❑REPAIR O i� SC —6 � / �� �u �
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Sup lemental Fee �$20
401 to 800 Am ere f� $50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
IRCUITS / FEEDERS Transformer / Power Su i for Si ns / Outline Li htin �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNfCATION, flEMOTE COFlTROL, SIGNALING Circuits and Two tnspection 7rips Each Dwelli Unit �$8Q
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each Svstem Device or Anoaratus �$.50 Investiaative Fee
Lighting Retrofit � $25 per Fixture
Center Pivot Irriaation Boom � $4C
� $30 oer Fbur
total fee is
on tlie dates
�
TNIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOTCOMPLETED WITHIN 18 MONTHS
FOR OFFlCE USE ONLY
I Illlll fllll INII 11111 Illll IIIII I�III IIIII IIII Illl
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Request Date: Rough-in inspection Required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now � II Call
���� r You must call fhe inspec[or when ready! Date Ready: �
I certi(y that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Address (Sireet, Box, or Route No.) , City „ Zip Code
I Section
' I Range I Fire No.
�;
Electrical Contractor / Company Name
�A11�9� HTCa, A/C �LECT., INC.
, i.E..—
Mailing ��tra�C�r Owner
Authorized S' ture ( tractor,
E6�00001A-73 7/1/2000
PFrone
;
; _-
� BOApD OF ELECTAICRY COPY
Number
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�� -7s7 G�ao� I
INSTAUCTIONS ON BACK OF YELLOW COPV