P - 81542REQUEST FOR ELECTRICAL INSPECTION
1�2 2 6 4. 1 �� . Minnesota Board of Electricity
�� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
' �� (651) 642-0800 TTY/MRS 1-800-627-3529 � � �
www. electricity.state.mn. us
IdentiTy the work covered by this requesY. ���%� /��� T
❑ NEW ❑ REMODEL ❑ADDITION REPAIR /
GENERAL F S Outdoor Li htin Standard (� $1
S VICES / POWER SUPPLIES Tratfic Si nal Standard �$5
0 to 400 Amoere �$25 �/S/� Su lemental 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 FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Addftional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fixture
Center Pivot Irriaation Boom � $40
�
Transformers u 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 andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$8f
Addftional Inspection Trips � $20
Investiaative Fee
PoF
total fee is
tlie eiectrical installation described herein an the dates sfated:
FOR OFFICE USE ONLY
� ��ii�� ��i�i iit�� i�i�i i� � i�� f ��1 ��,� � •
i � ��t�i « i ii��
� i O z z 6 4 1 3� .iViJ`�O
Request Date: Roughtin Inspection Required9 ❑ Yes No Inspecdon Other Than Rough-In: Ready Now ❑ Will 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:
�ob; �iress (street, eoxt °fi A°ute 7°�! / _ �__ C'_H . i> . zip coes
Range
�j �� I►
�pu� f4".r���uc ,p1�rc..
�`��! /� �sS�23
Mractor �icense Number Mester License Number
or Owner Performing
L� � �,�/
EB-00001A-13 7/1/2000 � BOARD OF ELECTAICRY COPY � INSTRUC710N3 ON BACK OP YELLOW COPY