P - 791271-70��—�07 7❑
❑ NEW ❑ REMODEL ADDITI� ❑ R
I�l� r' r�- Jt9 �+a d t-c.
GENERALFEES
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL f
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Li hfinq Retrofit �$.25 per Fixture
Center Pivot Irri ation Boom $4U
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites $5
Se arate Bondin Ins tion $20
S 'al Ins 'ort $30 r How
S ial Ins tion $.31 r Mile
THIS INSTALLATION MAY BE OR[
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
2 Describe -using the back of the white copy if necessary - the work covered by this request:
r'O C'� d�.
Outdoor Li h6n Standard $1
Traffic Sianal Standard (�a $5
Su lemental Fee $20
Transfortners u to 10 KVA $10
Transfortners over 10 KVA $ 20
Transiortner I Power Su I for Si ns I Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes lhe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins tion Tri s $20
Investi a6ve Fee
Reins 6on Fee $20
TOTAL FEE Jl Ii� �
(minimum total fee is $20) �� z
THIS MEA FOR INSPEGTOR USE ONLY
I hereby certity thal inspected the electrical insW� described herein on the dates staled:
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Request Date: Rough-in Inspection Required? Yes ❑ No Inspedion Other Than Rough-In: ❑Ready Now Wdl Call
��s— (� You must call the inspedor wt�en ready! Date Ready. _
I certiry that I am the f�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Address (�reet, Box. a Route Fb.) City T�p Code
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ower s�pprer Po� suppr nderess
;ontractor / ComP�Y Name Contr�r License Number Masta �ectriaan a Power Limited Technician
/zAd'tiM�� /YL� V1 �f�C.. ��� �Q � a License�mber
lailing Address (CoMractor, any or Owner Perfaming InstaBation)
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,uth ' 'gnature nhaCOr� C pany a �er Perfortning Insfal(ation} Phon (s) .
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ON BACK OF YELLOW COPY BOARD OF ELECTRICITY COPY EB-00007M14 8.1_ 20D2