P - 80092REQUEST FOR ELECTRICAL INSPECTION
� Minnesota Board of Electricity
1� 3 2 6- 9 4 6� 1821 University Avenue Suite S-128, Saint P5ul, Minnesota 55104
' � (651) 642-0800 TTY/MRS 1-800-627-3529 /
www.electricity.state.mn.us � �� '��'
Identify the work covered by this request:
❑NEW EMODEL ❑ADDITION ❑REPAIR �� �� � / ! �� `���
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES I POWER SUPPLIES Traffic Si na4 Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
IRCUITS / FEEDERS Transformer / Power Su I ior Si ns / Outline Li htin �$5
0 to 200 Am re�$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Insoection Trips �$20
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
.TIFAMILY DWELLINGS (PER UNI'T)
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
I Home Park Lots �
Vehide Park Sites �
idina Insoection (� $:
Fee (�
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total fee is
I herebvi certiN that I insoecled the electrical inslalla6on described herein on the dates steted:
S ecial Ins ection �$.31 er Mile � �Q �� 7— � �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED I T COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Requ Da �y Rough-in Inspection Required? ❑ Yes � o Inspection O[her Than Rough-In: ❑ Resdy Will Call
��� '" Y You must call the inspector when ready! Date Ready:
1 certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job ddress (Street, Box, or Route No.
/ ) City 7rp Code
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Address
�' � �1'I�''' �f'l: ELECT., 1�
135fi2 LENTRAL �1V�. N.E.
Address (C . o r wrfnmu�
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'�.B-00001A-13 7M/2000 , ARD OP ELEC7RICRY COpy
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Master License Number
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