P - 80519, REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity �
��� 1 O- 6 0 3� 182� University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us
identify the work covered by this request: '�
❑ NEW ❑ REMODEL ❑ADDITION ❑ REPAIR �v`''�-�' '"'� ��/�-- �
GENERAL FEES door Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si cial Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transfortners over 10 KVA (� $20
CIRCUITS / FEEDERS Transformer I Power Su for Si ns / Outline li hti �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 fncludes the Service andlo� Power Supply up to 5�0 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$SO
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins io� Tri s�$20
Each S stem Device or A ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins 'on Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 co 12 Units �$5o Per UnR (minimum total fee is $20
EaCh Additi0�81 Unit �$25 WF INSPECTqi USE ONLY
OTHER ADDITIONAL FEES � y/ ' ��
Li htin Retrofit �$25 er Fixture � �l ��
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots �$25 I herebvi certifv that I insoected the electrical installatlon des�x�ed herein on me dates siated:
S ial Ins ion �$30 r Hour '"'"`�""" /�� """
Special Inspection � $.31 per Atile ( � � � � �i' �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED� OT COMPLETED WITHIN 18 MONTHS
FOR OFFlCE USE ONLY
flllllllllllllllll1111lllllllll111111111flllllllll /�. � �o,sa
�E 1 1 7 D 6 Q 3 3�E /G ��3�� �
I ceAiiy that 1 am
Rough-in Inspection Required? ❑ Yes Inspection Other Than ough-I • eady Now � Will Call
You must call the inspector when readyl Date Ready: O+
:NSED CONTFiACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
u[e No.) C • Tap Code
tr1�r� �� IJC� �Y ( C� �1 ��32
Power Supplier "
Elect ' ntractar / Company Name
Meiling A ress Contractor, Company
l�h/.
Authorized ig ture (Co ctor, Com�
�GK-
E&OOOOtA-13 7!1/2000
�
� `
or Owner Perfortning InsTallation)
�
��
Number
a . � L�'Z T�l -��O �
BOARD OF ELECTRICRY COPY INSTRUC710N3 ON BACK OF YpL191�OFY �