P - 78309• REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
. 1-386-449 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 –
(651) 642-0800 TTY/MRS 1-800-627-3529
Iwww.electricity.state.mn.us �'� ' °"�
Identify the work covered by this request: � �
O NEW EMODEL ❑ ADDITION ❑ REPAIR I�— �
GENERAL FEES Outdoor Li h Standard 1
SERVICES / POWER SUPPLIES Traffic Sianal Standard ��5
Above 800 Ampere � $75
CIRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A paratus �$.50
ADDITIONS TO THE GENERAL I
MULTIFAMILY DWELLINGS PER UNIT)
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htln Retrofit �$25 per Fi�ure
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites � $5
Transtormers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformers / Power Supply for Sipns / Outline Liphtinq �
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$f
Additional Inspection Trips � $20
Reins ection Fee � $20
Z �c, ' ` � '�� �+ TOTAL FEE
`� � (minimum total fee is $20) � �
FOR INSPECTOR USE �ONLYf /' �
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I hereby certity that I inspecteG the electrical installation tles ibed herein on the dates stated:
ROUGHIN . DATE
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FMIAl��NSPECTION � p DATE
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FOR OFFICE USE ONLY
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Reque t D`ate_ Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-in: ❑ Ready Now ill Call
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('/V 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:
Jo�dress (Street, Box, or Route No.) Ciry ' Zip C�
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Section Township Range Fire No. County ,
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Authorized Sic
EB-00001A-13
Phone
OF ELECTRICITY COPY
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Master License Number
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INSTRUCTIONS ON K OF