P - 79715REQUEST FOR ELECTRICAL INSPECTION
� _ � � ^ - � O � 0� Minnesota Board of Electricity =
[ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� a� P (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us �(� (�S' �'1'� _
Identity the work covered by this request:
❑ NEW ❑ REMODEL ❑ADDITION EPAIR � �l/�L.I O�
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 io 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am re�$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su pl for Si ns / Outline Li htin �$5
0 to 2� Am re �$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 Addftional Ins ection Tri s�$20
Each S stem Device or aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Rein tion Fee �$20
MULTiFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$50 Per Unit (minimum total fee is $20
Each Additional Unit � $25 f0" �"��0" � �"�v
OTHER ADDITIONAL FEES �'
Li htin Retroffi �$25 er Fixture
Center Pivot I' atlon Boom �$40
Manufactured Home Park Lots �$25 I hereby ce ' that I inspected the electrical installaUon described Frer�n an fhe dates s�t�:
Recreatio�al Vehicle Park Sites (� $5 101GHN °"'�
Se rate Bondin Ins ection �$20 Z.� "O2-
S ial Ins ection �$30 r Hour `*'""�"`�"a' ����
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FOR OFFICE USE 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 oute No.) City Zip Code
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Pow r Su 'er Address
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rical Contractor / Company Na e CoMractor License Number Master License Number
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�ling Addre= (Contract ompany or OWOer P�erfo�nstalf�ia� �� � /1 _ �� �� �p
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Authorize Sig ture (Contractor, Co pany or ner Performing Installation) Phone
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EB-00001A-13 7/1/2000 � BOARD OF ELECTRICITY COPY . INSTHUCTIONS ON BACK OF YELLOW COPY