P - 81939REQUEST FOR ELECTRICAL INSPECTION
1 114 13 4� Minnesota Board of Electricity -
� r � 182i University Avenue Suite S-12$ Saint Paul, Minnesota 55104
- `�_ v (651) 642-0800 7TYIMRS i-800-627-3529
www. electricity.state.mrz. us "�'
Identify the work covered by this request: �i �� sv—
❑NEW ❑REMODEL ❑ADDITION EPAIR ' ` - r����C' �" J ��
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES I POWER SUPPLiES Traffic Siqnal Standard �$5
Above 800 Ampere � $75 �
CIRCUITS / FEEDERS
0 to 200 Am re �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or aratus �$.50
ADDITIONS TO TNE GENERAL FEES
OTHER ADDITiONAI FEES
Recrea6onal Vehicle Park Sites (�
5eoarate Bondina Insoection � $;
Su lemental Fee � $20
Transformers up to 10 KVA �$10
Transformers over 10 KVA � $20
Transfortner / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service aad/or Power Suppty up to 50� Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$8C
Additional Insoection Trips � $26
I insoected fhe electrical installation
total fee is
Special Inspection �$.31 per Mile � L- 2�'"8 r �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED �"htOiCOMPLETED WITHIN 18 AAONTHS
� _—.�__..---_ _ - --_ _ — _ _______---- ---
FOR OFFICE 118E ONLY
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Request Date: Aough-in Inspectlon Required? ❑ Yes o Inspection Other Than Rough-In: eady Now ��II Call
�-Qp� `U You must call the inspecror whe� readyl Date Ready: O!�(,J
I ceRify that I am the�LICENSED CONTRACTOR �(COMPANY ❑ OWNER and hereby request inspectian of the electrical work at:
Job Address (Street, Box, or Aoute No.) Ciry �P
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Section Township Fire No. Coun
8 9 - �4 K
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Power�lier .� Address
E i I Co qactor / Campan N CoMracror Licenae Number Master License Number
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j Mailing Address
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or O�ev(�r PelfeimingAfistallation) Ptlone ,�..^ . p,,,�"� /'1 ,�i
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E&OOOOtA-13 7/t/2000 BOAR�OF ElEC7A1CRY COPY INSTRUClWNS ON BACK OF YELLOW COPY