P - 81935REQUEST FOR ELECTRICAL iNSPECTiON
1"� 0 J���� 7 �� Minnesota Board of Electriciry
1821 University Avenue Suite S-128, Saint Paul, M�nneso
� �� � (651) 642-0800 TTYIMRS 1-800-627-3529 -
www. electricity. state. mn. us
Identify the work covered by this request: �
❑NEW ❑REMODEL ❑ADDITION EPAIR ��,
GENERAL FE S Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
Above 800 AmperE
CIRCUITS / FEEDERS
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aretus �$.50
ADDITIONS TO THE �ENERAL FEES
to 12
Retrofit � $25 cer Fixture
55104 `�
;� ...;
Su lemental Fee � $20
Transformers up to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outiine Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two inspectiort Trips Each Dwelli Unit �$B(
Addftional Inspection Trips � $20
� Investiaative Fee
I herebv certilv ihat I
total fee is $20) �..10
herein on ihe dehs s�ted:
S ial Ins ection �$30 er Hour '°'°"""'
Special Inspection �$ 31 per Mife
C�- �7- �'J
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
WR OFFlCE UEE ONLY
I l��lll �IIII11l�I �1�11 ���II I�ll�� ���11 ���� I�'� �� �°a° i
� s og�987 0 � aO<sa
H uest D _� f Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-In: Ready Now � Will Call
` You must call the inspector when ready! Date Ready:
I cerGfy that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
��cst�� ��l �L ��,t l _ �� _ �: . � . � �---.
Mailing Address (Contrador, Com any or Owner
V � ^
AuthAFZed Siqnature (Contractor,.Qompany or O
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BOAND OF ELECTRICRY COPY
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