P - 80159REQUEST FOR ELECTRICAL INSPECTION
% °� Minnesota Board of Electricity °�
1�� O (- g 0 4 `���°e (651) 642 0800 ATTY/MRS11 00 62 3529Paul, Minnesota 55104
` www.electricity.state.mn.us " '
Identity the work covered by this request:
❑NEW I�REMODEL �ADDITION ❑REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am re �$25
401 to 800 Am ere �$50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am re �$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Apparatus �$.50
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Recreational Vehicle Park Sites �
Seoarate Bondina tnsoection � $�
t"'�C�� �
Outdoor Lighting Standard �
Traffic Sianal Standard (� $5
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to SUO Amperes, AN
Circuits and Two Inspecclion Trips Each Dwellin Unit �$80 4�
Additional Insaection Trips � $20
� Reinspection Fee � $20
wa ixsr�cror+ usE aar
I herebv certiN that I insoected the electrical
total fee is
d hereifi on Hie �tes stated:
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED 1F-NOT COMPLETED WITMIn i s nnvn i ns_ _
FOR OFFlCE USE ONLY
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Request Date: Rough-in Inspection Required? � Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now W Will Call
8-2 V—QZ You must call the inspector when ready! Date Ready:
I certity that I am the [� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Sheet, Box, or Route No.) City Zip Code
5164 St. Moritz Drive Fridley
Sec[ion Township Range Fire Na. Counry
( Occu M I Phone
tjb xomes
Power Suoolier Add�OSS �
Elecfrica! Cont�adw / Company Name 1 Corrtrador �icanse Number Master Lice�ae Number
Lazer Electric, Inc. � � CA01110
Mailing Address Contractor, Company or Owner Perfortning Installation)
8164 thur Street NE., Spring Lake Park, NIDI 55432
Authorize ig ture (Contractor, or Owner Performing Inffialtation) Phone
763-784-3729
E - 3 7/i/2000 BOARD OF ELEC7AICITY COPY WSTRUCTIONS ON BACK OF YELLOW COPY