P - 79552� ^ REQUEST FOR ELECTRICAL INSPECTION
1 2 3 2 6 3 7 Minnesota Board of Electricity
s � �;�` 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� ���„� (651) 642-0800 TTYIMRS 1-800-627-3529
www.electriciry.state.mn. us
Identity the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDVTION ❑ REPAIR �
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am ere �$25
401 to 800 Am re �$50
Above 800 Am re � $75
CIRCUITS / FEEDERS
0 to 200 Am re �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus �$•50
ADDITIONS TO THE GENERAL FEES
5 �-fX�Q 1�'
Outdoor U htin Standard f� $1
Traific Si nal Standard 0$5
Su demeMal Fee d $20
Transfortners u to 10 KVA �$70
Transformers over 10 KVA � $20
Transformer ! Power Su for Si ns / Outline Li hGn �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dweliing Unit � SB(
_- — — -- _ -
3 to 12 Units �$5o Per Unit (minimum total fee is 0) i; �
Each Addi6onal UnR � $25 `°"'�°ECro� "s� °"`Y
OTHER ADDITIONAL FEES (
L' htin Aetrofit �$25 r FuRure � I
Center Pivot Irti Gon Boom ��t0
Manufactured Home Park Lots �$25 I nere ' inspected tl,e electrical insqpation described herein an me dares stated:
Recreatia�al Vehide Park Sites � S5 "01G"'" w�
Se arate Bondin I ' n�$20
S 'aI I 'on � $30 r Hour "w` "s`�"0° ��
S 'al I 'on � $.31 r Mile
TH{S INSTALLATIQN MAY BE (3RDERED DISCONNECTcD IF NOT COMPLETED VY/YTHIN 18 MONTiiS
— - ---_ ----- —__------_---------- - -----------.�..._..�......_._...__.. �
POH OFFGt USE �NLY
llililllilillillllilllll1111111111illlllllllllllil �
�E 1 2 3 2 6 3 7 7� ��2 ��`��
Requesi Date: Raugh-in inspectian Required? ❑ Yes o Inspection Other Then Rough-In: ❑ Ready Pbw W� Catl
1�"'v� You must caU the i�spactor when ready! Date Ready:
I certify �at I am the�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereb st inspection of the electrical work at
Job Address (Sireet, Box, or Route No.) Ciry Zip Cude
�� G � C -
Section Township Range Fire No. � unty
��� �� e ��'�
� OccupaM
� Mailing Address (ConVactor, Company or
. � � /'
�d�� z � � �
CoMractor Lice�e Number Mast
rn¢r Perfortning Installation)
. _ _ � s. . . . �
EB-00001A-13 �/2000 � 80ARD OFE�ECTRICITY COPY INSTAUCTONS ON BACK OF YELLOW COPY