P - 79868REQUEST FOR ELECTRICAL INSPECTION
Q ° � Minnesota Board of Electricity
1°� o i� O O J � a t821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�� ,� (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us
Identify the work covered by this request:
❑ NEW ❑ REMODEL ❑ADDITION ❑ REPAIR
GENERAL FEES 0 r Lighting Standard �$1
0 to 400 Am ere �$25
401 to 800 Am ere �$50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am re � $10
ALARM, COMMUNICATION, AEMOTE CONTROL,
C{RCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus �$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fixture
CeMer Pivot I' don Boom �$40
Manutactured Home Park Lots � $25
Recreational Vehicle Park Sites � $5
S rate Borniin Ins ' � $20
S ial Ins ion �$30 r Fbur
Soecial Insoection � �.31 oar k�ile
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA f� $20
Transfortner / Power Su I for Si ns / Outline Li hdn �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
fncludes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelli Unit �$8(
Additionai Inspection Trips � $20
Investiaative Fee
I hereW cerUfv ihat I
num total fee is $2
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6on desc�ed herein on C�e dates sta�d:
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF COMPLETED WI7HIN 18 MONTHS
FOR OFFICE USE ONLY
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Request Date:' Rough-in Inspection Required? ❑ Yes ❑ No Inspecfion Other Than Rough-In: Ready Now � Will Call
��S ' O� You must call the inspector when readyl Date Ready:
I certify that I am the�I.ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspedion of ihe electrical work at
Job Addre (Street, Box, or Route No.) City ^+� Z�P C�
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Section Township Range Fire No. County
OoaiPent Phone
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Power Supplier / Address
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Installation)
Coniractor License Mumber I Master License
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EB-00001A-13 7!1/2000 BOAfiD OF ELECTRICRY COPY INSTRUCTIONS ON BACK OF YELLdW COP�I