P - 82015, REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
� i� � �� g 8 3 �^ 1821 Universiry Avenue Suite S-128, Saint Paul, Minne ota 55104
'�' (651) 642-0800 lTY/MRS 1-800-627-3529
www.electrieity,state.mn.us �--�-F�
Identify the work covered by this request: � f,�,
❑ NEW ❑ REMODEL O ADD4TION p REPAVR `�r
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / PQWER SUPPUES Traffic Si nal SlandaM �$5
0 to 400 Am ere �$25 Sup lementai Fee C� $20
401 to 800 Am ere C� $50 Transformers u t� 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 re �$10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$S(
CIRCUITS, CIRGUITS OF LESS THAN 50 VOLTS pdditional Ins ion Tri s�$20
Each S stem Device or A araWs �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinsoection Fee �$20
Retrofit � $25 ner Fixture
I herebvi certfv that I inscected me electdcai installation
fee is
S ial Ins ion �$30 r Hour �°"'°'"'"" '�_ � """ I
Special Inspection � $.31 per Mile ��1� �i
THIS iNSTALLATION MAY BE ORDERED DISCONNECT�D IF NOT COMPLETED WITHIN 18 MONTHS __
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Requ t: Fiough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-In: ady Now ❑ Will Call
You must call the inspector when ready! Date Ready:
{ ce ' ihat { LICENSED CONTRACTOR ❑ COMPANY ❑ OVYNER and hereby request inspection of the electrical work at:
Job Addr 5 tr t, , or No.) ily ' Z�
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Section ownship Range Fire No. County
OxuParrt 1/ 1 1 i 1 ��/� 7 Y i�� �/� ��A
Contractor
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Authorizad Si�t�►��ic�onj�m wner Perfo / Phone
(763) 535-2000
EB-OOOOtA-13 7/1/2000 BOARD OF ELECTAICIT/ COPY INS'TFiUCTION3 ON BACK OF YELLOW COPY