P - 78605REGlUEST FOR ELECTRICAL INSPECTION
1 � � � � � � °tl 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
Identify the work covered by this request: /
❑ NEW ❑ REMODEL ❑ADDITION ❑ REPAIR �� wr r � f �tJ/'l2Lr � � � �%�"" E�( IS� �C
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Trensformers over 70 KVA �$20
CIRCUITS / FEEDERS Transfortner / Power Su I for Si ns / OuHine Li hfi �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACW UNIT
Above 200 Am re �$10 Includes the Service andlor Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri �$20
Each S stem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Rein ion Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE �
3 to 12 Units �$50 Per Unit (minimum tOtal fee is $20)
EeCh Additi0n81 Ullit (�? $25 WA �NSPECTOIi USE ONLY
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots �$25 I hereby certiry that I inspected me electricel instaNahan described herein an me detes slated:
Recreational Vehide Park Sites � $5 -� "01GH1N ��
S rate Bondin Ins ection �$20
S ial In ion �$30 er Hour FlNpLNSPECtON • ��
S ecial Ins ection �$.31 er Mile �� 'd
THIS INSTALLATION MAY BE ORDERED DISCONNECTED OT COMPLETED WITHIN 18 MONTHS
FOR OFFICE l�E ONLY
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I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route o.) Cily Zip Code
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Section Township ^ O� `�nge Fire No. County �
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Occupant P one
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Power upplier Address
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EI ' 1 Contrador / Company Name ,� Co ctor^ License Number Master License Number
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Mailing Address (Contractor, Compan or Owner Performing Installation
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Authorized Signature (Co or, Co ner PeAorming Installation) Phone
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EB-00001A-13 7/1/2000 . BOARD.OF ELEC7RICRY COPY � INSTRUCTIONS ON BACR OF YELLOW COPY