P - 81730REQUEST FOR ELECTRICAL INSPECTION
Q �� Minnesota Board of Electricity °�
�� "� �� J�� 3 4 �` ,� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
• � °� ��� (651) 642-0800 TTY/MRS 1-800-627-3529
'11 www.electricity.state.mn.us "�'
IdentiTy the work covered by this request: �{! I_
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❑ NEW REMODEL ❑ ADDITION ❑ REPAIR � —�
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES I POWER SUPPLIES Traffic Sianal Standard �$5
401 to 800 Am ere �$50
Above 800 Am re � $75
IRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOL7S
Each S stem Device or ratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
Liphbng RetroM � $25 per Fixture
Ceen�r PFroI lrtipdion Boan i ZIt
M�nd Flonx PaA� Lots • f
Transformers u to 10 KVA �$10
Transtormers over 10 KVA � $20
� Transtormer / Power Supply for Signs / Outline Lighting �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 500 Amperes, AII
Circuits and Two Inspection Trips Each Dwellin Unft �$8(
Additional Inspection Trips � $20
Investiaative Fee
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' (minimum total fee is
an �e dates stated:
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S ial In ' A t.31 A�e �
_ TtiIS INSTALLATION MAY BE ORDERED DISCONNECTED NOT COMPLETED WITHIN 18
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-In: ❑ Rea Nc
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.� , j (�J I. ��YOU must call the inspector when ready! � Date Ready: � �� �� I
I ceRify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecGical work at
Job Address (Street, Box, or Route No.) City Zip Code
lQ i'1r s � " l �
Section Township pange Fire No. Coun
Occupant . ,� • Phnnu
Electrical Cor
BLAIN�
Name
�LECT., INC.
�l�. N.E.
4lwner PeAorming
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License Number
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EB-00001A-13 7/1/200p,... , t_ , BOARD OF ELECTRICRY COPV INSTRUCilON3 ON BACK OF YELLOW COPY