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P - 79906REQUEST FOR ELECTRICAL INSPECTION �� � � � � 0 °� �P Minnesota Board of Electricity - E � � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 � � (651) 642-0800 TTYIMRS 1-800-627-3529 www.electricity.state.mn.us " ' Identity the work covered by this request: r� S L_ �' I d� a yn �O e� ,� p �t, v � NEW ❑REMODEL ❑ADDITION ❑REPAIR GENERAL FEES Outdoor L' hti Standard �$1 SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5 0 to 400 Am re �$25 Su lemental Fee �$20 401 to 806 Am re �$50 Transformers u to 10 KVA �$10 Above 800 Am ere �$75 Transformers over 10 KVA �$20 CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5 0 to 200 Ampere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT CIRCUITS OF LESS THAN 50 VOLTS MULTIFAMILY DWELLINGS (PER UNI'n 3 to 12 Unfts �$50 Per Unit Each Additional Unit � $25 OTHER ADDITIONAL FEES Manufactured Home Park Lots � � $30 oer Hour Includes the Service andlor Power Supply up to 500 Amperes, All CircuRs and Two Inspection Trips Each Dwellin Unit �$8( Additional Inspection Trips � $20 Investiaative Fee I total fee is S fNSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 FOR OFFlCE USE ONLY G'1� I IIII�I IIlil IIIII Illl! LlII! 411!! Illll IIILI LlII IIII ���? 3E 1 Z 5 5 7 6 O 9� �� � o[�� S� 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 NoJ City Zp Code 1 aa. � D�'► o v►, dqa. 5-�- ��` � c�! � ✓��� 3�. Occupant I - �.� ci-a. �- C� r e Power Supplier Electrical Contractor / Company Name � Mailing , v g N O � 0..r Phone �S d.�� y �s� � f �. � /5 rn�V Co actor License Number Mast License umber � �`� �� 6� Company or Owner Performing Installation) �. < < t r� � � � ls m,v ,�s�3 do o ny or er Performing Installation) Phonet �r ��� �� (i � 9�d 3 BOARD�OF ELEC7AICRY COPY INS7AUC710NS ON BACK OF YELLOW COPY