P - 80536�.. REQUEST FOR ELECTRICAL iNSPECTfON
Minnesota Board of Electricity °�
1� 16 8- 4 0 4 z 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� � �e° (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us " '
�❑ NEW ❑ REMODEL ❑ ADDITION O REPAIR
GENERAL FEES
0 to 400 Am ere �$25
401 to 800 Ampere � $50
Above 800 Ampere � $75
�UITS / FEEDERS
0 to 200 Ampere � $5
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTRQL, SIGNALING
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Dev�e or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
dditional Unit � $25
OTHER ADDITU
I Retrofit � $.25 per Fixtu
Pivot irrigation Boom � $
ctured Home Park Lots �
6onal Vehi�e Park Sites �
le Bondina InsoecUon � 9
�
Outdoor Lighting Standard � $1
Traffic Si nal Standard � $5
Su demental Fee � $20
Transformers u to 10 KVA (� $10
Transformers over 10 KVA � $20
Transtormer / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 500 Amperes, All
Circuits and Two i ection Trips Each DweUi Unit �$8(
Additional Insaectbn Trips � $20
� 6' �
I herebv ceAiN that I in
total fee is
desaibed herein on the dates
-�ti-�3 I
THIS INSTALLATION MAY BE ORDfRED DISCONNECTED IF NOT COMPLETED w�Tri1N i e nnun � ns
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? [] Yes ❑ No Inspeclion Other Than floughdn: eady Now � Wilt Cali
'�/ You must call the inspector when readyl Date Ready:
i certity that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecVical work at
Job Address (Street, Box or Route No.) Zip Code
S�s/ `'���,% S� ��.��- s3`s!��z
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C. INC.
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Phone
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License Number
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Authorized Sign ractor, Company or er Perfortning Installation) Phone
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E&00001A-13 � /1l2000 � BOARD OF ELECTRICRY COPY INS7AUC710N8 ON BACK OF YELLOW COW