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P - 80123REQUEST FOR ELECTRICAL INSPECTION �� Minnesota Board of Electricity °� 1� 2 3 2�� H � e ° 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 . � �s {651) 642-0800 TTY/MRS 1-800-627-3529 www. electriciry. state.mn. us " ' Identify the work covered by this request: ❑ NEW �EMODEL ❑ ADDITION ❑ REPAIR �3a� -oa� 0 to 400 Am ere �$25 401 to 800 A re �$50 Above 800 Am ere � $75 CIRCUITS ! FEEDERS 0 to 200 Am re �$5 Above 200 Am re � $10 ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Each S stem Device or A aratus �$.50 ADDITIONS TO THE GENERAL FEES MULTIFAMILY DWELLINGS PER UNI 3 to 12 Units �$50 Per Unit Each Additional Unit � $25 07HER ADDITIONAL FEES Liahtina Retrofit � $25 oer Fixture Outdoor Li hting Standard � $1 Traffic Si nal Siandard � $5 Su demental Fee � $20 Transformers u to 10 KVA �$10 Transformers over 10 KVA f� $20 Transfortner / Power Su I fa S' I Outline Li M' �$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT Includes the Service ancllor Power Supply up to 5W Amperes, All Circuits and Two Inspection Trips Each Dwellin Unit (� $80 Additional Ins ection Tri s�$20 Investi ative Fee Reinsoection Fee � $20 (minimum total fee is $20) �p, < SPECTOH USE ONLY ,(/ -// /,� P��—�—� _� `/� d Y� �� fr S "�L� �6v certifv that I insnected the electrical insteAabon described herein on tlie dates sla�ed: arate Sondi fi 'on � $20 � S ial Ins ion �$30 hbur FINAL INSPECrION wre S ecial Ins ection �$.31 Mile ' ZZ THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS �� FOR pFflCE USE ONLY I Ilil�l llill llill itllllllll 111�111l�1 illll llll illl � o �E '1 c 3 2 6 4 8 4* �0 � Reque ate: � Rough-in Inspection Required? ❑ Yes ❑ No Inspecfion O[her Than Rough-In: ❑ Ready Now � Wilt Call -- � You must call the inspector when ready! Date Ready: I certiTy that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspectlon of the electrical work at Job Address (Street, Box, or Route No.) City �P �18 15 �ol 1 �:l �� 1 - s� Section Township Range Fire No. ounty ■�� ElecVical Contractor / Company Name Mailing Address (CoMractor, Company or i u -1 � �ri ...� L � Ptwne Master License Authorized ' natu o ctor, Co or Owner eAorming Installation) Phone 1 t9 1g - uS�t � EB-OOOOtA-13 BOMD OF ELE COPY . IN5fALCT10N8 ON BACK OF YELLOW COPY