P - 79742REQUEST FOR ELECTRICAL INSPECTION .�
Minnesota Board of Electricity ��—�
1��� 4���� ��� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 ��0�
- www. electricity.state. mn. us
Identity the wark covered by this request: ��.y�� ���"�� �,�%� �� L�f ��
/i �
❑NEW ❑REMODEL ❑ADDITION �REPAIR % � � �
0 to 400 Ampere � $25
401 to S00 Ampere � $50
Above 800 Ampere � $75
�UITS / FEEDERS
0 to 2� Ampere � $5
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CO
CUITS, CIRCUITS OF LESS THAN 50
Each System Device or Apparatus �
ADDITIONS TO THE GEP
_TIFAMILY DWELLINGS (PER UNI'�
3 to 12 Units (� $50 Per Unit �
Each Additional Unit � $25
OTHER ADDITIONA
Lighting Retrofit � $25 per Fixture
Center Pivot Irrigatbn Boom � $40
Manufactured Home Park Lois (� $25
Recreational Vehicle Park SRes � $5
Hour
Traffic Si nai Standard � �b
Su lemental Fee � $20
Transformers up to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for 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 Inspectidn Trips Each Dwellin Unit �$8(
Add'Rional Ins ection Tri s�$20
Investi tive Fee
Reins ion Fee � $20
TOTAL FEI
(minimum total fee is $20
�,�.�,� �Oo}z/�(e�S
�
�g �h s
I hereby certily that I in�d the e
3-
n an the
� /
%,x"'r
0�
��
FOR OFFICE USE ON�Y
Illllllllllilllfilllliillliiilllllllll illl 1l I p��� .
! II II �
�E 1� 4 4 7 7 5 O�E fv� ��, ��
Request Da e: Rough-in Inspeqion Required? Yes ❑ No Inspection Other Than Rough-In: ❑ Ready N Will Call
!� p�� Q� You must call the inspector wh rea 1 Date Ready:
1 ce�iiy that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecVical work at
Job Address (�t,�r Royte o.) ��� City /� Zip Code
� U
ection Township Range ire No. Coun _ ��, _
O
� �
Power Supplier
Ele ' ntracto / m
aili Address (ConVa c
thori ignat {CoN
EB-00001A-13 7/1/2000
Company or Owner Performing Ins�allation)
��
Phone
f'� ��G
BOARD OF ELECTRICRY COPY
���
l/G�!'J ��C/C � �
INSTRUCTIONS ON BACK OF YELLOW COPY