P - 81600REQUEST FOR ELECTRICAL INSPECTION
1 � � � � � 7 � � � ; Minnesota Board ofi Electricity =
� � � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� �a�...�� (651) 642-0800 TTY/MRS 1-800-6273529
www.electricity.state.mn.us " '
Identify the work covered by this request:
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❑ NEW O REMODEL ❑ ADDITION EPAIR �,
GENERAL FE S Outdoor Li htin Standar �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 io 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Amoere �$50 Transformers uo to 10 KVA �$10
0 to 24Q Amoere �
CIRCUITS OF LESS THAN 50 VOLTS
Init � $25
OTHER ADDITIONAL FEES
Manufactured Home Park Lots �
� $30 cer Hour
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppiy up to 500 Amperes, All
Circuits and Two Inspec6on Trips Each Dwelli Unii �$8(
Additional Insoection Tnos � $20
total fee is
I herebvi certifv that I insoected the electrical installation described herein on
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FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes No Inspec[ion Other Than Rough-In: ❑ Ready Now Will Call
-- �Q (� You must call the inspector when ready! Date Heady: �"' Z��
I certi(y that I am_the CENSED CANTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:.
Job Address (Street, x, or Route No.) City Zip Code
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EIecS icel Conhador / Company Name
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Mailing Address (CoMractor, Company or Owner
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uthorized Signature (Contractor Co or
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E&00001A43 7/7/2000
Pfrone
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ing Installation)
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BOAHD OF ELECTRICRY COPY
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INSTAUCTIONS ON BACK OF YELLOW COPY