P - 80516REQUEST FOR ELEGTRICAL INSPECTION
'1-16 ���F � 6 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.mn. us
Identity the work covered by this request: ��—
❑NEW ❑REMODEL ❑ADDITION ❑REPAIR L^G,y�i' /
GENERAL FEES Outdoor Li htin Standard �$1
SERV{CES / 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 �$70
Above 800 Am ere �$75 Transformers over 10 KVA (� $20
CIRCUITS / FEEDERS Transformer / Power Su i for Si ns / Outline Li htin �$5
U to 2�� Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Secvice ancUor Power Supply up to 5fl0 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Ins ion Trips Each Dwellin Unfl �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S stem Device or A ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinsoection Fee �$20
Lighting Retrofit d$25 per Fi�ure
Center PNot Irrigallon Boom � $4C
Manufaciured Home Park Lots � $
Recrea6onal Vehicle Park Sites � ;
Separate Bonding Inspection � $2(
SDecial Insoection � $30 cer Hour
total fee is
I herebvi ceAi(v that I insoected tfie electrical installation described herein on the dates stated:
�
FOR OFFICE USE ONLY
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Request Date: Rough-in lnspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: eady Now � Wtll Call
�' t� � o/ You must call the inspector when ready! Date Ready: � � ' I
1 certify that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecUicSl work at:
Job Address (Streei, Box, or Route No.) / Ciry � Ztp Code /�
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Section Township Range Fire No. Counry
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Occupant � ,/ JUN� QL n,n Qho'
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Mallirle �re��t �,�/
' ' ��m Raoids. MN
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EB-00001A43
ETRIC. INC. _.� ..3� .w
i erforming Installation)
55 .
:ompany or Owner Perfo i Installadon) Phone
BOApO OF ELECTRICfTY CAPY
Number
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� ON BACK OF YELLOW COP f�