P - 80189REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity '� ��
� 1-396-146 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529
www. electricity. sta te. mn. us
Identify the work covered by this request:
O-�IEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
to
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or paratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS (PER UNI�
3 to 12 Units �$50 Per Unit
Lighting Retrofit � $25 per Flxture
Cerner Pivot Irriqation Boom � $40
Mile
XCEL ENEROY SAVER'S SWITCH
Transformers u to 10 KVA �$10
Transfortners over 10 KVA � $20
Transfortners / Power Supply for Signs / Outline Lightinq �$!
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unrt �$80
Additional Inspection Trips � $20
FOP INSPECTOP USE ONLV
ROUGH IN
i1Mrt1. HY91
TOTAL
total fee is
linsoected the electricalinstallaUOn described
DATE
DATE
�_/� � p3
___ � = _ _ ^ u�s..ca•=— — — — — — — — — — — — — — — — — — — — — — — —
FOR OFFICE USE ONLY
I IIIIII IIIII IIIII IIIII IIII) I� ����
*1396i46i * �i�� �
� �
Reque���/Q'2 Rough-in Inspection Required? ❑ Yes �lo InspecUon Other Than Rough-in: IaReady Now ❑ Wfll Call
You must call the inspector when ready! Date Ready:
I certi(y that I am the L� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address�. sox�a`� ST HE °ity FRIUI..EY zip �e 5543
Section Township Ra�ge Fire No. County p(��(�j
°`�"�I'�REK JE�DIAH � 8� f Pn«,a
1
Power Sup➢lie[. �E�Y Address
x�x�
Electrical Gqp wt c1pcJ �o�ypl�pq��.r.,� Contraclor Lic� Alulloh0�. Master License Number
r•��riv � ��.ty i rn►�, w vutsts�i
Mailing A� ��i�ny.a40�Aer1 P��g� � ���y�N 55114
ra�Au
Authorize nature (�racto mparry or Owner Performing Instaltation) Phone �� ���,
��
EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY