P - 79638REQUEST FOR ELECTRICAL INSPECTION
� Minnesota Board of Electrici � �
1- � 4 4- 0 2 2� q 182� ����e�s��, A�e��e S��te S 28, Saint Paul, Mi�nesota 55104
�`' a� �°° (651) 642-0800 TTY/MRS 1-800-6 9
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Identity the work covered by this request: � -
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nai Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin f� $5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Supply 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 �$20
Each S stem Device or aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$5o Per Unit (minimum total fee is $2
EaCh Additional Unit �$25 � ��PE�T�p USE ONLV
OTHER ADDITIONAL FEES ���,� 7� . z Y- �3
Li htin Retrofd �$25 er Fixture
CeMer Pivot Irri atlon Boom �$40
Manufactured Home Park Lots �$25 here ce ' that I ins ed Ure eledrical ir�tallalion described herein on Ihe dates slated:
Recreational Vehicle Park Sites � $5 �"" °ATE
Se rate Bondin Ins ection �$20
S ial Ins ection �$30 r Hour �'"�"�"0N 0A7E,r�
S ial Ins ecfion �$.31 r Mile '�� �/
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: Ready Now ❑ Will Cali
� Q� �� You must call the inspector when ready! Date Ready: " �
I certify that I am the ICENSED CONTR,4CTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Address (Street, x, r Route No.) C' Zip Code
D — S�3 �+r � s���a
Section Township Range Fire No. County
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Occupant � „ Phone
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Power Supplier � l Address T
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EB-00001A-13
L 1� 1 Il � V. � 1\ V. I CoMrador Licens�
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$ry��r�wner Perfortning Installation) ��Ff--
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BOARD OF ELEC7RICITY COPY
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NSTRUC710NS ON BACK OF YEILOW COPY