P - 82530REQUEST FOR ELECTRICAL INSPECTION
�., � 0 2 3� J O� �: �; Minnesota Board of Electriciry °"�
€a 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�. ,�e.e,�„ (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us
Identity the work covered by this request � Ga _i �� `� ��G �� ���(L7"' /
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❑ NEW ❑ REMODEL ❑ ADDITION REPAIR
GENERAL F S Outdoor ' hti S ard �$f
SERVICES / POWER SUPPLIES Traffic Si nal 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 600 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
1 0 to 200 Am ere �$5 � p ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere d$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATiON, REMOTE CONTROL, SIGNALIMG Circuits and Two Inspection Trips Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20
Each S stem Device or A aratus �$.50 Investl tive Fee
ADDITIONS TO THE GENERAL FEES Reinsoection Fee �$20
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Home Park Lots �
lehicle Park Sites �
total fee is $201 ���Ja �
installation described herein on the dates
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FOR OFFICE USE ONLY
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ReQuest Date: Rough-i� Inspection Required? ❑ Yes o Inspection O[her Than fiough-In: ❑ Ready Now Q Will Call
� ��(� You must call the inspector when readyl Date Ready: �� f (� (> (�
I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, a Route� Ciry� Zip Code
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wn Township Range Fire No. C ty
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Address (CoMrac[or, Company or Owner rfortninf
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EB-OOOOtA-13 7A@000
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CoMractor License Number Master License
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BOARD OF ELECTRICITY COPY �� IN37AUCTIONS ON BACK OF YELLOW COPY