P - 80469REQUEST FOR ELECTRICAL INSPECTION
• Minnesota Board of Electriciry
1-381-456 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �'`
(651) 642-0800 TTY/MRS 1-500-627-3529
www. electricity, stafe. mn. us
Identify the work covered by this request:
O�tlEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERALFEES
SERVICES / POWER SUPPLIES
401 to
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or aratus �$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS (PER UNI�
3 to 12 Units �$50 Per Unit
Center Pivot Irripation Boom �
KCEL EhtERGY SAVER'S �WITCH
Su lemental Fee � $20
Transtormers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformers / Power Su I 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 Twa Inspection Trips Each Dwelling Unit �$80
Additional Inspection Trips � $20
Investiqative Fee
Reinspection Fee � $20
TOTAL FEE
(minimum total fee is $20)
FCH INSPECTOR USE ONLY
I hereby certify Mat I inspectetl ihe
ROUGH IN
dates sfatetl:
DATE
'�t,c. � /Sl �
FOR OFFICE USE ONLY
IIIIlIIUIII�NIII�IUIIIINII�III��l�I �s�� .
''13814561 * �J ��5�
Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-in: Ready Now ❑�II Call
0�/28/01 You must call the inspector when ready! Date Ready:
I ceRity that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY