P - 79529REQUEST FOR ELECTRlCAL INSPECTION
1 2� 1 2 8 8 8�� Minnesota Board of Electriciry
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�- ? � (651) 642-OS00 TTY/MRS 1-500-627-352
www. electricity. state. mn. us `'�'
Identify the work coveretl by this request:
❑NEW ❑REMODEL ❑ADDITION ❑REPAIR
GENERAL FEES Outdoor Li htin Stand rd �$1
SERVICES / POWER SUPPL(ES Traffic Si nal Standard �$5
0 to 400 Am ere C� $25 Su iemental Fee �$20
401 to 800 Am ere (� $50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns I Outline Li 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 Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS AddRional Ins ection Tri s�$20
Each S stem Device or aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Unfts �$50 Per Unit (minimum total fee is $2
EBCh AdddiOnal Unit �$25 FOII INSPECTOR USE ONLV
OTHER ADDITIONAL FEES ��� f '�/'�'�-
Li htin Retrofit �$25 er Flxture
Center Pivot Irri tion Boom �$40
Manufactured Home Park Lots �$25 I here cerufy that I ins ed the electrical installation des�xibed herein on the �tes �d:
Recreational Vehicle Park Sites � $5 "�"'" °"'�
Se arate Bondin Ins 'on � $ZO
S ecial Ins �on �$30 r Hour """'"�"'�' % °"'�
S ecial In ion �$.31 r Mile `�r ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection. Required? ❑ Yes ❑ No Inspection Other Than Rough- Now ❑ Will Call
�I � �O must call the inspector when ready! Date Ready:
1 certify that I am the�16ENSED CONTRACTOR ❑ CQMPANY ❑ OWNER and hereby request inspection of the eiectrical work aT.
Job Address (Street, Box, or Route No.) C' e Z�P �e '/
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EB-00001A43
Phone
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BOAFiD OF ELEC7AICRY COPY
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Master License
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INSTRUC710NS ON BACK OF YELLOW COPY