P - 77688REQUEST FOR ELECTRICA�. INSPECTION ��
1� O�F-� - 6� 6 Minnesota Board of Electricity �: ()O� �� �. ��
: ' � 1821 University Avenue Suite S-128, Saint Paul, Minnesota��
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(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
�scribe •using the back of th hite copy'rf necessary - the work vered by this reques
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GENERAL FEES Outdoor Li hting Standard $1
�ERVICES / POWER SUPPLIES i Traffic Sianal Standard fa� $5
Above 800 Am ere $75
CIRCUITS / FEEDERS
0 to 200 Am ere a$5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CANTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unit
Each Additional Unit (� $25
Retrofit
ued Home Park Lots a$25
nal Vehicle Park Sites a$5
Bondin Ins ection $20
spection $30 per Hour
spection $.31 per Mile
ALLATION MAY BE ORDERED DI
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1847686L
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns / Outiine Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins dion Tri s $20
Investi ative Fee
Reins ection Fee $20
TOTAL FEE � j � J�
(minimum total fee is $20) l
THIS ARErI FOR INSPECTOR USE ONI.Y
I hereby certi(y that I inspected ihe electrical installation described herein on the dates stated:
D IF NOT COMPLETED WITHIN 12 MONTHS
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Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspedion Other Than Rough-In: ady Now ❑ Will Call
�l ���� You must call the inspector when ready! Date Ready:
I certiFy that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspedion of the eledrical work at:
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Township Section Range - Fire No. County� „
I Electrical
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ON BACK OF YELLOW COPY
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BOARD OF ELECTRICITY COPY
ie Two (2) Phone Numbers Including
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\ Master Electricianp� �P�ower Lim
1 License NumberLJ�7nii�
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EB-00001A-15 8.7 200d