P - 81587REQUEST FOR ELECTRICAL INSPECTION
1�4 4 315 �.° Minnesota Board of Electricity
�a � a" ° i821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� �° �+; (651) 642-0800 TTY/MRS 1-800-627�529
www.electricity.state.mn.us `�'
Itlentity the work covered by this request: •
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR lJ� V� "V ` h�
GENERAL FEES 0 r Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Ampere �$25 Su lemental Fee �$20
IRCUITS / I
0 to 200
Above 2i
ALARM, COP
e (�
C�7
:UI7S OF LESS THAN 50 VOLTS
n Device or Apparatus � $.50
ADDITIONS TO THE GENERAL FEES
�WELLINGS (PER UNI�
s � �50 Per Unit
Retrofft � $.25 per Fixture
'ivot Irriaation Boom � $4(
� $30 per Hour
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 and/or Power Supply up to 500 Amperes, Ail
Circuits and Two Inspection Trips Each Dwelling Unit �$8(
Additional Ins ection Tri s�$20
Investiqative Fee
� Reinsoection Fee � $20
WR OFFICE USE OMLY
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� 1 D 4 4 3 1 S B x
total fee is
ir�stallatlon described herein
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Requ Date: Rough-in Inspection Required9 ❑ Yes Inspection Other Than R h-In• ady Now ❑ Will Cell
You must call the inspector when ready! Date Ready: t
I certify that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
E8-OOOOIA-13 7/1/2p0p BOMD OF ELEC7AICITY COPY INSrNUCT10N8 ON 6ACK OF YELIOw coP1/