P - 79923' REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity "�
+ 1-396-187 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 _
(651) 642-0800 TTYIMRS 1-800-627-3529
www. electricity. state.mn. us '
Identity the work covered by this request:
U�9EW 0 REMODEL 0 ADOITION ❑ REPAIP X�EL Et�ERC3Y SAVER�,S SW�TCH
GENERAL FEES Oatdoor Li htin Standard �$t
SERVICE5/ POWER SUPPLIES Traffic Sional Standard �$5
401
CIRCUITS ! FEEDERS
0 to Z00 Am ere C� $5
Above 2�0 Am ere � $1�
ALARM, COMMUNICATION, REMOTE CONTROL, SIGt
CIRCUITS. CtRCUITS OF LE55 THAN 50 VOLTS
Each System Device or A paratus �$.50
ADOf7�ONS TO THE GENERAI FEES
MUL7�FAMILY OWELLINGS (PER UNIT}
3 to 12 Units C� $50 Per Unit
Each Additional Unit � $25
LighGng Retrofit � $25 per FiMure
Center Pivot irrigation Boom � $4C
Manufactured Home Park Lois � $
Aecreationaf Vehide Park Sites �
Separate Bonding Inspection � $2�
Special Insoeclion C� $30 oer Hour
Su tementaf Fee C� $20
Transformers u to 10 KVA (� $10
Transformers over 10 KVA � $20
Transtormers / Power Supply for Signs / Outlioe Lighting �$!
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andtor Power Suppiy up to 500 Amperes, Ail
Circuits and Two Inspection Trips Each Dwetting Unit �$80
Additional inspection Trips � $20
investi ative Fee
Reinspection Fee � �2�
TOTAL FE
(minimum total fee is $2t
FOR INSPEGTORUSEONLY
i heteby c
aoucH iN
F�NA��NS�
I inspected the electrical installation describetl herein on the dates statetl:
oarE
DATE
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FOR OFFICE USE ONLY
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Feque�! ��ro� Rough•in inspection Required? ❑ Yes C�No inspection Other Than Rough-in: �Ready Now ❑ Will Call
You must cail the inspector when ready! Date Ready:
1 certify that i am the 1�4 LICENSED CONTRACTOR ❑ CQMPANY ❑ OWNER and hereby request inspection of the electricai work at:
Jotr Address����' so���o��N ST t�tE ��`� FRIDLEY Zip Code ���'
Section Township Range Fire No. County A�{A
Occu ant Phone
pNEI.�uON JC?HN C3 �(J r�, (, r
Power Suppiier Ad re
XCEI. EhlERCsY
Electrica�� t�raTc,tE� maan��am����Ti�� Contractor Uce�,,nfs�e N�u �r3 Master License Number
4ilt{
Mailing r s iSi�IL.R�RlALyKClOAl7r�P$A11Y1 �� ����ufN 55114
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Authorized � nature (Contractor, ,ompan or Owner Performing Installation) Phone
Y
�i ��� �+'� $���'�
EB-Oq001A-13 711/2000 BOARD OF ELECTRICITY COPY �NSTRUCTIONS ON BACK OF YELLOW COPY