P - 81878REQUEST FOR ELECTRICAL INSPEC710N
� � 0 3 0 31 ��q Minnesota Board of Electricity —
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�e,?�? (651) 642-0800 TTYIMRS 1-500-627-3529
� '�,�j l� � www.electricity.state.mn.us
Identity the work covered by this request:
❑NEW REMODEL ❑ADDITION ❑REPAIR f,Q�� — g
GENERAL FEES Outdoor Li hGn Standard �$1
401 to 800 Am ere �;
Above 800 Am re � ;
IRCURS / FEEDEAS
0 to 200 Am ere �$5
Above 200 Am re � ;
ALARM, COMMUNICATION,
CIRCUITS, CIRCUITS OF L
Each Svstem Dev+ce or
Each Additional Unit �
Manufactured Home Park
Recreational Vehicle Park
�
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to i0 KVA �$10
Transformers over 10 KVA � $20
Transformer I Power Su for Si ns I Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspecfion Trips Each Dwetlin Unit �$8(
Additional Ins ection Tri s�$20
lnves6 ative Fee
Reinsoection Fee � $20
total fee is
l►'�J,
ial in ' �$.3�r Mile � Z^ ✓� �^ G� �
THIS INSTALLATION MAY BE ORDERED DISCONNECT'ED IF OT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE Ol/lY
I IIfIN IIIII IIIII IIIIi 1111111I�II flll� Elllllll ��° •
�s i flsa�gs� ,�'� 3(00
Request Date: Rough-in Inspection Required? ❑ Yes No Inspectlon Other Than Rough-In: ❑ Ready Now Wili Call
� `� You must call the inspector when readyl Date Ready:
I certify that I am the LICE D CONTRAC70Ft ❑ COMPANY ❑ OWNEA and hereby request inspection of fhe elecbical work at
.
Job Address (Street, Box, or Ro City Zip Code
l � Vd �S�! 3?�
Section Township Range Fire No. Co _
�
EB-00001A-13
Address
:�cv�•r • -
AV�. N.E.
ner Performing Installation)
Phon I uJ� �� � 1� t�� /
Phone
.�. I ��3-�S�-�Zo2� I
OF EIECTAICRY COPV INSfRUCT10N8 ON BACK OF YELLOW COPY