P - 77769REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity =�
� 3 4 7- 3 7 2 182� University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OS00 T'fY/MRS 1-800-627-3529
www. electricity. state. mn. us
Idcrrtify the work covered by this request:
❑ NEW REMODEL ❑ ADDITION ❑ REPAIR �� � O O
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic S' nal Standard �$5 t
0 to 400 Am re�$25 S emental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS . _ � w Transformer / Power Su for Si ns / Outline ' htin �$5
ALARM, COMMUNICATION, REMOTE CONTROL, 51
CIHCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each em Device or aratus �$.50
ADDITIONS TO THE GENERAL FEE
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unft
Each Additanal Und � $25
OTHER ADDITIONAL FEES
Li htin ReVOfit �$25 r Fixture
Center Pivot I' ation Boom �$40
Manutactured Home Park Lots �
Recreational Vehi�e Park Sftes � S5
Se arate Bondin Ins 'on � $20
S 'al In 'on � $30 r Hour
SpeaallnspecUon � $.31 per Mile
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Ins ection Tri s Each Dwellin Unit �$8f
Addi6onal Ins ectlon Tri s�$20
Investi ative Fce
Reinscection Fee � $20
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total fee is $2�1 �� !
I hereb ce that I inspected the electrical ir�stallation described herein on the dates sfated:
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FlHAL IN9PECTION �+.� r M' J
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and herebY request tiepec�on Of ltle electr� Mrork at
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NOTICE T0: �nstauerotwriny
Minnesot�B�rd of Electricity
Inspection Repor# Form
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The following items are deviations from the accepted standards of construction at the above described premises.
Numbers after each item reference the applicable National Electrical Code sections.
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CORRECT TI,- E NOTED DEFICIENCIES and:
�otify the inspector for re-inspection before covering
❑ Re-Inspection will be made at the final inspection
❑ Sign and retum this form to the contract inspector when corrections have been completed,
but no later than
Contract Inspecfor ,� �-- , f Slgnature of Installer
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Telephone Number
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White — Installer
Date
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- � A copy of this'�grt rvill become a permanent
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record of�fhis� inspection ��t the _Board of
� � �� % �� i Electricity. Form EB-00116-04 (6199)
Canary — Boar�,pf-�I�C� �r Pink Area RepresentaGve Green - Inspec�or
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