P - 81550REQUEST FOR ELECTRICAL INSPECTION
� Minnesota Board of Electricity �""
� ���� ���, �� s� a 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�, °'� � (651) 642-0800 TTY/MRS T-800-627-3529
www. electricity. state. mn. us
Identify the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR r ��
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES ! POWER SUPPLIES Traffic Si na! Standard �$5
0 to 400 Amuere �$25 i Su demental Fee �$20
CIRCUITS / FEEDERS
0 to 200 Amoere �
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL f
MULTIFAMILY DWELLINGS PER UNI
3 io 12 Units �$50 Per Unit
Each Additional Unii � $25
Retrofit � $25 oer Fixture
�
Transformers up to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$8f
Additional Insoection Trips � $20
total fee is
SPECTOR USE IXiLY
�N_ y_ �fi �
that I insoected the electrical inshalla6on described herein on the
-7 -� � �3
18 MONTHS
FOR OFFICE USE ONLY
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R�u�S�D r� Rough-in Inspection Required? ❑ Yas ❑ No Inspection Other Than Rough-In: eady Now ❑ Will Call
IYou must call the inspector when ready! Date Ready:
I certiiy that I am the�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
��`���Streat. �' �`rn��t�n c� -�v�� i�l�J,l Z�p��S��a
Range � Fire No.
� Address
Phone �j��
/ �
Electrical Contractor / Comparry Name Cont Licena
DEPENOABLE ELECTRIC, tMG. v
Mailing ( r, o ing Installation)
C�on RaAids. MN �433
Authorized Signature (Con r, Company or Owner Pert i Installatlon)
E&00001A•7 7/7/2000 � BOARD OF ELEC7AICRY COPY
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1__ INSTRUCTONS ON BACK OF YELLOW COPY