P - 77327REQUEST FOR ELECTRICAL INSPECTION
1 3 4 7 5 � 8 Minnesota Board of Electriciiy
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 -
www.electricity.state.mn.us S ,� /3 f �
IdentHy the work covered by this request:
❑ NEW ❑ REMODEL �ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re(� $25 Su lemental Fee �$20
401 to 8Q0 Am re (� $50 Transfortners u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
C RCUITS / FEEDERS Transformer / Power Su for Si ns / Outline Li htl �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Suppty 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 Additional I ion Tri s�$20
Each S stem Device or ratus �$.50 Inves6 ative Fee
ADDITIONS TO THE GENERAL FEES Reins 'on Fee 8$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to t2 Units �$50 Per Unit (minimum total fee is $20)
Each Additional UnR � $25 � ��P�� �E ���
OTHER ADDITIONAL PEES 1'°�—
Li hU Retrofit � S25 r Fxlure
Center Pivot Irri ation Boom �$40
Manufactured HOme Park Lots �$25 I hereby ce' that I in the electrical installa6on described herein on the dates stated:
Recreational Vehicle Park Sites � $5 "01GX1N �- °ATE f�
Se rete Bondin In ion �$20 !t----�--U ��� v
S ecial Ins 'on (� $30 er Hour FlNAL INSPECTION � �
S' In ' n�$.31 r Mile ��_
_ THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WIT IN 18 MONTHS
FOR OFFICE USE ONLY /� /% �^�^�y�
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Requ t Da� Rough-in Inspection Required? Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ill Call
Q� You must call the inspector when ready! Date Ready:
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY OWNER and hereby request inspection of the electrical work at:
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Mailing Addi�ss�
Authorized Signature
EB-00007A-13 7/1/2000
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Company or Owner Performing Installation)
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Contractor License Number
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Master License Number
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