P - 81873REQUEST FOR ELECTRICAL INSPECTION
1�� � 3- 2 2 5 �a � Minnesota Board of Electricity
�� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� .
�: . �; (851) 642-0800 TTY/MRS 1-800-827-3529
www. electricity. state. mn. us
tdentify the work covered by this request Q
EW ❑ REMODEL ❑ ADDITION ❑ REPAIR IV
GENERAI FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 4D0 Am ere �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above 800 A e�$75 Transfortners over 10 KVA �$20
CIRCUI7S / FEEDERS Transformer / Power Su I(or Si ns ! Outline Li htin �$5
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A � aratus �$.50
ADDITIONS TO THE GENEFiAL f
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit f� $25
OTHER ADDITIONAL FEES
L' ti Retrof'd �$25 r Fixture
Center Pivot Irriaation Boom � S40
nspection � $21
� $30 oer Hour
ONE & TWO FAMiLY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 500 Amperes, All
Circufts and Two Inspection T' s Ead� Dwellin Unft �$8(
AddiUOnal Inspection Trips � $20
Investiaative Fee
total fee is
I herebv certlfv Mat t insoected tlie electrfcat installaM1On desaibed herein on
vJ
IS
FOR OFFlCE U8E ONLY
11I1�11 II��I Irlll III�� IIIII I��II Illll llll INl ���3 �� ,
� 1 1 o��z5� � ao-�a
Requ�� Rough-in InspecMion Required? Yes Inspection Other Than Rough-In: eady Now 0 Will Catl
{� � You must call the inspector when readyl Date Ready:
I certify that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecGon of the electrical work at:
Job Address Street, Box, or Route N �ity Zi
�'31 �. �(� �rt��s nv �� �vi � l�v �5�,��
�
�—
EB•OOOOtA43
Name
/1 ,
Phone
CoMractor license N�
^- Z
��� �
,
�ne���''
BOARD OF El.ECTpICT/ COPY
License Number
��c.�— a `t��" I
x+srnucnoris a+ awcK oF reuow covv