P - 78300REQUEST FOR ELECTRICAL INSPECTION
% Minnesota Board of Electricity ��
1��� 1- 3 5 5 1821 Universky Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
' www.electricity.state.mn.us
Identify the work covered by this request:
❑ NEW ❑ REMODEL �ADDITION ❑ REPAIR
0 to 400 Am ere �$25
401 to 800 Ampere � $50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
j. 0 to 200 Am ere �$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus �$.50
ADDITIONS TO THE GENERAL FEES
3 to 12 UniGS �$50 Per UnH
Each Additional UnR � $25
OTHER ADDITIONAL FEES
Lighting Retroffi � $25 per Fixture
Cenier Pivot Irrigation Boom � $40
Manufactured Home Park Lots �
Recrea6onal Vehicle Park Site� �
Separate Bonding Inspection � $2 �,
Special Inspection � $30 per Hour
Special Inspection � $.31 per Mile
THIS INSTALLATION MAY BE (
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Outdoor Liahtina S ndard � $1 �
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su for Si ns / Outline Li hti �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
CircuBs and Two Inspection Trips Each Dwellin Unit �$8C
Addftional Ins ection Tri s�$20
Inves6qative Fee
Reinsoection Fee � S20
use a+iv
total fee is
the electrical installation described herein on the dates stated:
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_ _ COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLV �� �
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Request Date: Rough-in Inspection Required? Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now .Will Call
," �� You must call the inspector when readyl Date Ready:
I certi(y that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY �OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) C' Zip Code
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Section Township Range Fire No. C n
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Occu ntG.� ►� 305 4 Ph���— �c" ��Y15
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Power Supplier Addre
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Electrical ConVactor / Company Name Contractor License Number Master License Number
� Mailing
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EB-00001A-13 7/1/2000
or Owner Performing Installation)
or Owner Performing Installation)
BOAHD OF ELECTAICI7Y COPY
3 _ � _ �-��'�
INSTHUCTIONS ON BACK OF YELLOW COPY