P - 79760" REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
- 1-396-540 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 -
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. sta te. mn. us
Identify the work covered by this request:
x
❑ NEW 0 REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
SERVICES / POWER SUPPIIES
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
TIFAMILY DWELLINGS (PER UNIT
3 to 12 Unfts �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITI01
Lighting Retrofit � $25 per Fixture
Center Pivot Irrigation Boom � $40
Manufadured Home Park Lots � $
Recreational Vehicle Park Sites � ;
Separate Bonding Inspection � $21
Special Insngction � $30 per Hour
XGEL ENEROY SAVER'S SWITGH
Transtortners u to 10 KVA �$10
Transfortners over 10 KVA � $20
Transformers / Power Supply for Signs I Outline Lighting �$°
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 Insoection Trios � $20
FEE
FOq INSPECTOR USE ONLY
I hereby cerMy that I inspected the electrical ins1e11eM1On descnbed herein on tha dates slate
ROUGMIN DATE
fINAL INSPECTION /� DATE
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�1MFs�TEDJF_N�I �MPLET_E�lN1TJ�L18_N�ONTHS
FOR OFFICE U8E ONLY
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Reque Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-in: Heady Now ❑ WIII Call
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:
dob Addresg�7.70' �'F11"1 O 1 IYC C�� �R�y�,�� �P �e rJ�c
Section Township Range Rre No. County
Occu��E�� �N Q 0� ti, Phone
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Power Syppy_a{ ��Y Address
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Electri / TI� Contractor Li�� Master License Number
Mailing ��,�n�� � ,�ti°�� �14
AutFrorize nat re ( r c o an or Oxmer Performing Installation) Phone �1 ���1,�
EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YEILOW COPY