P - 82033� REQUEST FOR ELECTRICAL WSPECTION
1` 1�3 3 0 5 3� Minnesota Board of Electricity —
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(657) 642-0800 TTY/MRS 1-800-627-3529
www.electrtcety.state.mn.us '� ���'
Identify the work covered by this request: ��� �`t�,s� n j � r (�� �.,C,� �Q���
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❑NEW ❑REMODEL ❑ADDITION ❑REPAIR
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
4o1 to 80� Am re �$50 Transformers u to 10 KVA �$10
Above 600 Am ere C� $75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su for Si ns / Outline Li htin �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 2�� A re �$10 Includes She Service andlor Power Suppty up to 5� Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection TriQs Each Dwellin Unit �$8�
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S stem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$�
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE ),�� 'J,��
3 to 12 Units �$50 Per Unit (minimum total fee is $20) 7(Jt
Lighting Retrofit � $25 per Fixture
Center Pivot Irriaatlon Boom � $4(
� $30 per Hour
� $.31 cer Mile
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ihe elec9rical i described herein on tlle dstes stated:
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FOR OFF7CE USE ONLY
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�eques ate: Rough-in Inspection Required? �es ❑ No Inspection Other Than Rough-In: ❑ Ready Now�ll Call
�� v l You must call the inspector when ready! Date Ready:
I certify that I am the �,LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
J Address (Street, Box, or Ro No.) Ciry Zip Code
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Name
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or Owner F
Phone
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EB-00001A-13 7/1/2000 BOAHD OF ELECTRICfTY COPY
Number I Mester License
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INSTRUCTIONS ON BACK OF YELLOW COPY