P - 79772' REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
. 1-396-556 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS i-800-627-3529
www.electricity.sfate.mn. us
Identify the work covered by this request:
� NEW ❑ REMODEL ❑ ADDITION 0 REPAIR
GENERALFEES
401 to 800
G
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus �$.50
ADDITIONS TO THE GENERAI FEES
MULTIFAMILY DWELI.INGS (PER UNI
3 to 12 Units �$50 Per Unit
FEES
$25 per Fixture
on Boom � $40
XGEL ENERQY SAVER'S SWITCH
Outdoor Liahtina Standard � $1
Transfortners u to 10 KVA �$10
Transfortners over 10 KVA � $20
Transfortners / Power Supply for Signs I Outline Lighting �$!
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unft �$80
Additional Inspection Trips � $20
Investiaative Fee
TOTAL FEE
J fee IS $20)
FOF INSPECTOF USE ONLV
I hereby certily Mat I inspected the elecMACaI installation described herein on the detes sfatetl:
ROUGHIN DATE
FINAL INSPECTION DATE
� � 2-7-G3
- �� "�"�" � � FOR OFFICE USE ONLY
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Reques) ��� Rough-in Inspection Required? ❑ Yes IA,No Inspection Other Than Rough-in: �Ready Now ❑ Will Call
- You must call the inspecta when. ready! Date Ready: �
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Stregt, so���K �� c�,� FR��Y z�P coae ��
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Section Township Range Fire No. County
°aca�VERAf3E J4SEPH P '� Phone
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Power Syp�` � Address
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Authoriz ' nature (�ract om an or Owner Performing Installation) Phone �1 ���,1
EB-00001A-13 7H/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OFYELLOW COPY