P - 79824� REQUEST FOR ELECTRICAL INSPECTION
1- 2 6 8�� 17 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: ��������/� �..�T
❑REMODEL ❑ADDITION EPAIR /rt% l,/ ,Q.��L.-f �i(/ rJQ
GENERAL ES Outdoo htin Standard (� $1
SERVICES I POWER SUPPLIES Tra�ic Si nal 5tandard �$5
0 to 400 Am ere �$25 Su Iemental Fee (� $20
401 to 800 Am ere �$50 Transformers u to 10 KVA (� $10
Above 800 Amoere �$75 Transformers over 10 KVA �$20
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit (� $25
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fixture
Ce�ter Pivot 1' tion Boom �$40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites � $5 . _
Transformer / Power Su I tor Si ns / Outline Li htin (� $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Insoection Trios Each Dwellina Unit �$8(
Fee
Fee �
total fee is
tl�e electricaiinsMallaeon desc�ibed herein on
Special Inspection �$.31 per Mile ��—�r `����� 2-1��Z �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMP�ETED WITHIN 18 MONTHS
FOR OFflCE USE OlILY
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Request D. Raigh-in Inspection Required? ❑ Yes o Inspection Other Than Rough-In: eady Now ❑ WII Call
��i �� You must call the inspector when ready! Date Ready:
i ce ify that l am the LICENSED CONT'RACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of d�e electricai wak ah
Joby� re,ss (Street, Box, or Route No.) City Zip Code
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Address �p
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Electrical Contractor / Company Name
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Mailiny�Address (Corrtractor, Company
Phone
Contractor License Number
E&00001A-13 7/1/2000 BOApD OF ELECTRICRY COPY
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Master License Number
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Phone
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INSTRUCTIONS ON BACK OF VELLOW COP'