P - 80135REQUEST FOR ELECTRICAL INSPECTION
�� � � � � � e � Minnesota Board of E{ectricity
� � °�� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
���" �; (651) 642-0800 TTY/MRS 1-800-627-3529
' www.electricity.state.mn.us '� '
Identiiy the work covered by this request:
NEW ❑REMODEL ❑ADDITION ❑REPAIR
GENERAL FEES Outdoor Liahtino Standard �$1
to 400 Amcere �
I CIRCUITS / FEEDERS
CIRCUITS OF LESS THAN 50 VOLTS
ystem Device or Apparatus � $.50
ADDITIONS TO THE GENERAL FEES
OTHER ADDITIONAL FEES
Manufactured Home Park Lots �
Recreational Vehicle Park Sites �
Su lementaf Fee � $20
Transfortners u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su for Si ns / Outline Li htin �$5
ONE � TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$8(
Additional Inscection Tri�s � $20
I herebvi certifv that I
Fee �
total fee is
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dlation descnbed I�erein on tlie dates s�ted:
o�re
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�ED WITHIN 18 MONTHS
FOR OFFlCE USE ONLY
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R est Date: Rough-in Inspection Required? s ❑ No Inspec[ion Other Than Rough-In: ❑ Ready Now �II Call
�" [—LJ � You must call the inspector when readyl Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecdon of the electrical work aC
J` ddress (Street, , or Route No.) �` City �, Tip Code
./ 1`
Section Township ge Fire No. County
Occupant Phone
Power Supplier
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ig Address
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7/7/2000
or Owner Performing Installation) /�
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�any or Owner Performing Installatlon) Phone
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BOAHD OF ELECTAICT/ COPY INSTAUCTIONS ON BAdC OF YELLOW COPY�