P - 80445REQUEST FOR ELECTRICAL INSPECTION
,� _ � O � � � � � Minnesota Board of Eiectriciry
�.
��" iy 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
���� (651) 642-0800 TTYIMRS 1-500-627-3529
www.electricity.state.mn.us
Identify the work covered by this request: ' �� �� _�`'��—
1
❑ NEW ❑ REMODEL ❑ ADDITION REPAIR �i
GENERAL FEE Outdo r Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 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 i for Si ns / Outline L'+ htin �$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 Dwelli Unit �$80
CIRCUITS, CfRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S stem Device or A ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins tion Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE �'..�, j
3 to 12 Units �$50 Per Unit (minimum total fee is $20)
Retrofit � $25 oer Fixture
I herebvi certiN lhat I insoected the electrical
Recreational Vehicle Park
l�-z -
FOR OFFICE USE ONLY
I��IICI lilll IIIII IIIII Illlf Illl�lf�llll�ll IIII III�
�E 1 1 0 8 5 4 B 7�E ��%�� p��'S�
R uest Date: RougMin Inspection Requiretl? ❑ Yes No Inspection Other Than Rough-In: Ready Now � Will Call
� �' � � You must call the inspec[or when readyl Date Ready:
1 certify mat i am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Noute No.} Ciry Zip Code
r��� ( r� �� Q, �r— (l I— �—r � .—,1 �— � i F'.r 11.,1�`a-,
2
, � ► Pno�e
�
su�re� .
� Mafling qddrgss (Contraptor, Company or Owner
EB-00001A.13 7/1f2000 � ` BOARD�6F EI.ECTRICITY COPY � �� � /•J� P I