P - 79884REQUEST FOR ELECTRICAL INSPECTION
a�, Minnesota Board of Electricity �
1�� 9 2� 2 O 6 e 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
���,A (651) 642-0800 TTY/MRS 1-800-627-3529 � �
www.electricity.state.mn.us %-� `' '
IdentiTy the work covered by this request:
❑NEW , REMODEL ❑ADDITION ❑REPAIR � (yU � � / � l' ` U SS
GENERAL FEES Outdoor Li htin Standard �$1
SERV{CES I POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to S00 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIACUITS / FEEDERS ...__ � 1�,f' , Transformer / Power Su I for Si ns / Outline Li htin �$5
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
� Each Svstem Device or Aooaratus �$.50
Y DWELLINGS (PER
Jnits � $50 Per Unit
LigMir�g Retrofit � $.25 per Fixlure
Center Pivot Irrigation Boom � $4(
Manufactured Home Park Lots � $
Recreationaf Vehicle Park Sites �
ONE & TWO FAMILY DWELLINGS, EACH UNIT
includes the Service and/or Power Supply up to 500 Amperes, Alf
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Fee
(minimum totaf fee is $20}�(/, J
USE ONLY
296��.
iv that I insoected the electrical inslallatiai described herein on �he �tes siated:
-- FOR OFFlCE USE ON
4(jl{ 44! �'u �,0 296�1
� ������ I���I Il��1 C���� ���i� ����� ���I� ����� ���! ���� %� i
3E 1 2 9 Z c D 6 B iE ' 1 �
Request Date: Rough-in Inspection Required? ❑ Yes iJo Inspection Other Than Rough-In: ❑ Ready Now �II Call
���✓� You must call the inspector when readyi Date Ready:
I certiTy that I am the ' LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and he�eby request inspection of the electrical work at:
Job Address (SVeet, Box, Route No.) CAy Zip Cade
_ ,�Vc..�u.� f�Q.►� . � i �
Section Township Range Fire No. Counly
Oxupant
���
Power Supplier
Elechical Contractor /
B�—AI[JE H�I
CI
Mailing Address
Authorized re (C
/
EB-00001A-13 7H/2000
�TJ�"'ELECT„ il��.
r�AL AVE. N.E.
�.o y Performing
1 �. � ..
�
OF ELECTRICTf COPY
- 5�1-�I�3
�`-' � W � I
MS7RUCTWN3 ON BACK Of YELLOW COPY