P - 81836REQUEST FOR ELECTRICAL INSPECTION
.� 0 41 3 81 Minnesota Board of Electricity =
�� � °�°�� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
• (651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. state. rren. us
Identify the work covered by this request:
❑NEW ❑REMODEL ❑ADDITION EPAIR � V�aIC� � C�
GENERAL FE S Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES TraHic 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 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Inciudes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Tri s Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri �$20
Each S stem Device or ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins tion Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$50 Per Unit (minimum total fee is $20)
EaCh Addlti0n21 Unit �$25 f-0fl INSPECTOIi USE ONLV
Lighting Retrofit � $
CeMer Pivot Irrigatioi
Manufactured Home
Aecrea6onal Vehicle
Separate Bonding In;
Special Inspection �
iDITIONAL FEES
Fixture
Hour
I fiere6y certily that I insoecfed the electrical insfallaUon des�xbed herein on Ihe dat� sleted: I
FOR OFFICE USE ONLY
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I ce�ti(y that I am the � LICENSED CONTRACTOR �COMPANY ❑ OWNER and hereby request inspection of the eie�trical work at
Job Address (Street, x, or Route No.) Ciry Zip Code
5103 l I.� ,�a.�a,r� o�,-, �SS �r� � le �3
Section Township Range Fire No. County
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Occu nt
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actor / Company N e
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>(Contracto , Compa(i or Own r Pe i g I lation)
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pturea(Contrector, Co y er Performing Installf
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License Number
Q� 7� I
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Master License
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INS'TiIUC� ON BACK OF YELLOW COPY