P - 81802REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1�� 6 1� 7 6 3 �� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
, ;� � (651) 642-OS00 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us � � � " '
IdentiTy the work covered by this request:
❑ NEW �REMODEL ❑ ADDITION , ❑ REPAIR � �P,� ���%�L�( i _�Ci(/ Y % (� N ��YL"(
401 to S00
Above 800
�UITS / FE
0 to 200 A
Above 200
RM, COMW
�UITS, CIP
Each S stf
.TIFAMILY
3to12Un
GENERAL FEES Outdoor Li htin Standard (� $1 �
ER SUPPLIES Traffic Si nal Standard C� $5
ere �$7.S p6 Sup lemental Fee �$20
n ere �$50 Transformers u to 10 KVA �$10
� ere �$75 Transformers aver 10 KVA �$20
ERS 7ransformer / Power Su I for Si ns / Outline Li htin �$5
ere �$ff ONE & TWO FAMILY DWELLINGS, EACH UNIT
n ere �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
IICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$8(
ITS OF LESS THAN 50 VOLTS Additional In ection Tri �$20
Device or Aoparatus �$.50 Investiqative Fee
ion Fee � $20
TOTAI
(minimum total fee is
aar
' htin Retrofit � $25 r Fixture
CeMer Pivot I' ation Boom �$40
Manufactured Home Park LotS �$25 I hereby ce ' that I inspected the electrical installation tlesaibed herein on the detes stated:
Recreational Vehicle Park Sites � $5 �"'" °ATE
Se arate Bondin Ins ection �$20 �'��
S cial Ins ion �$30 er Hour """�101 (`� �,°"2 ���
S ecial Ins ection �$.31 er Mile 6`���5
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NO OINPLETED WITHIN 18 MONTHS
FOR OFFICE 118E ONLY
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R es te: Rough-in lrtspection Required? ❑ Yes o Inspection Ottier Than Rough-tn: ❑ Reacy Now Witl Call
� You 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:
Job Address (Street, Box, or Route No.) _ Ctty s �� Zip Cjode�� + e
t
�—
E&OOOOtA-13
Phone
/ %�� I —� I ,,.,..�..V.��
or Owner P�rtning Installatlon) ,
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or OyW� ing In el ron) J
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BOARD O LECTRI COPY
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1 / r ,L,�' .
Number Master License
i �a u� � `yn �t i
INSTAUCTIONS ON B K OF YELL COPY