P - 81943REQUEST FOR ELECTRICAL INSPECTION
1 12 8 O 1, 7°� ' Minnesota Board of Electriciry
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
? � � (651) 642-0800 TTY/MRS 1-800-627-3529 � �'
�www.electricity.state.mn.us ,Q" �+��
Identify the work covered by this request: �
❑NEW ❑REMODEL ❑ADDITION ❑REPAIR �i/(_,Q.. WY�'CC�.a—L._� r l
GENERAL FEES 0 oor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to B00 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CUITS / FEEDERS Transfortner / Power Su I tor Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Ampere �$10 Includes the Service and/or Power S t 500 Am
CIRCUITS OF LESS THAN 50 VOLTS
ystem Device or Apparatus (� $.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units �
Each Additional
Lighting RetroM � $25 per Fixtu
CeMer Pivot IrtigaHon Boom � $
Manufaccured Home Park Lots �
Recreational Vehicle Park Sites 8
Mile
upply up o peres, All
Circuits and Two Inspection Trips Each Dwelling Unit �$BC
�Additional Inspection Trips � $20
Investigative Fee
Reinsoection Fee � �20
roa
1 herebY ceAHV that I insoected the
� n�a �ry� ��+��w � ivrv mwr ese c�ROERED DISCONNECTED IF NOT COMPLETE�
total fee is
on tlre da�s stated:
18
I certify that I am
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LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the e�ecUical work at
or Route No.) �itY � Z�p C°de
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Range Fire No. County
Phone
� �c�d �a,vrii � s r- ��$
Address
:tor / Company
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(CoMractor, Cc
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EB-OOOOtA-13 7I1M2000
�B �'' I Contrector License
%G�IrG ��?
pany or Owner Performing Installation)
G�4-li �M � s't�/t�� _
C�mpany or er Perfortning Installation)
/ /� � BOARD OF ELECRi1CfrY COPY
License
7�(-U �
�rygTpUCT10NS ON BACK OF YELLOW� COP11