P - 79560REQUEST FOR ELECTRICAL INSPECTION
a�° Minnesota Board of Electricity
����� �� 8�� �� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
����' (651) 642-0800 TTY/M�00-627-3529 `
www.electricity.s�,zt�n. '� '
Identify the work covered by this request: r
❑ NEW � REMODEL � AODITION ❑ REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am ere �$25
401 to 800 Am ere �$50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am re �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Recreational Vehicle Park Sites �
Traffic Si nal Standard � $5
Su lementai Fee � $20
Transiormers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li htin �$5
ONE & 1W0 FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unft �$80
Additional Inscection Trios � $20
Fee
total fee is
I frerebvi certilv that I insoected the electrical insfalla6on desaibed herein on ll�e dates s�ted:
I I Special Insp�tion �$.31 per AMk I I
THIS INSTALLATION MAY BE ORDERED DISCONNECT
FOR OFFICE I�E ONLY
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L S 7� Q� � You must call the i � I � l
nspector when readyl Date Ready:
i certiiy that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Address (Street, Box, or Route No.) Ciry Zip Code
S.S�j G�srn�E �rca�l `�e..
Section Township Ran9e Fire No. Counly
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Address
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Electrical Contrador / Company Name
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Mailing Address (Contractor, Company or Owner Ped
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Authorized Signature (Contractor, Cam ny or Owner
EB-00001A-13 7/1I2000
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Phone
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Instellation)
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ming Ins ation) Phone
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BOAHD OF ELECTRICfiY COPY INSTHUCTIONS ON BACK OF YELLOW COVV