P - 79594. REQUEST FOR ELECTRICAL INSPECTION
� � � � � � � � � � s Minnesota Board of Electricity °
�e 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
. �� � (651) 642-0800 TTY/MflS 1-800-627-3529
www. electrici tv. stat�nin: cZs
Identify the work covered by this request: � R�� u}
❑ NEW ❑ REMODEL ❑ADDITION ❑ REPAIR
GENERAL FEES
401 to 800 Ampere � $50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am re�$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or aratus �$.50
AD�ITIONS T� THE GENERAL FEES
MULTIFAMILY DWELLINGS PEA UNI
3 to 12 Unfts �$50 Per Unit
Lighting Retrofit � $.25 per fixture
Cerrter Pivot Irrigafron Boom � $4t
Manufactured Hane Park Lots � &
� $30 oer Hour
Outdoor Li htin Standard � $1
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA (� $20
Transformer / Power Su I for Si ns / Outline Li hHn �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, PJI
Circuits and Two Inspection Trips Each Dwellin9 Unit �$8(
Fee �
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total fee is $20) �
I herebvi cerlilv that I insoected the electrical insqlladon described herein ai the dates stated:
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THIS INSTALLATION MAY BE ORDERED DISCONNECTE�iF NOT COMPLETED_WITHIN_ 18 �IAQ�N�._..
FOR OFFICE USE ONLY
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Request Date: Rough-in InspecGon Required? ❑ Yes � No Inspection Other Than Rough-In: Ready Now Will Call
y� l 3�d Z You must call the inspector when readyl Date Ready: -
I certity that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) Ciry Zip Code
S30 -hlilG,o Sr'N� �2/OLe y
Section Tow�ship Range Fire No. County
: ��0�
Occupant � Phone
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Power Supplier Address
Electrical Conirador / Company Name Contracror License Number Master License Number
�2TS �L�CT�2/C C�6ly
Mailing Address (Contractor, Company or Owner Perfortning Installation)
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A orized Signa�dor, Company or Owner Pertortning Installati Phone
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EB-00001A-13 �/1/2000 BOARD OF ELEC7RICITY COW INSTHUC710NS ON BACK OF YELLOW COPY