P - 80108REQUEST FOR ELECTRICAL INSPECTION
����4 �- 3 3 8 � 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 EMODEL ❑ ADDITION ❑ REPAIR � ( �-�-��5 ��i�' ��' � r` I �"' `\� / ``�/
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES ! POWER SUPPIIES Tratfic Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns I Outline Li htin �$5
0 to 200 Ampere �$5 E& TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Ser�ice a�d(or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING CircuRs and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20
Each S stem Device or ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinscection Fee �$20 !
OTHER ADDITIONAL FEES
Ligh6ng Retrofit � $25 per Fi�Aure
Center Pivot Irrigation Boom � $40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites � �5
I herebv certiN that 1
total fee is
Special Inspection � $.31� Mile _ _ � / �� f �" ��"�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFlCE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now Will Call
�` You must call the inspector when ready! � Date Ready:
I ceRify that 1 am the.�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of tlie electrical work at:
Job Address (Street, Box, or�oute N� C r/ , O� Zip���
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Section Township Range Fire No. County
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Occupant
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Power Supplier
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Ele� I Contractor / Company Name
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Mailing Address (Contracta, Company or
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Autho' Si ture (Contractor, C mpai
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EB-00001 -13 7/t/2000
Contractor License
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