P - 82017REQUEST FOR ELECTRICAL fNSPECTION
Minnesota Board of Electricity `°�'
��„ ����- 6 9 4 � 6� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
ee'�,�,,aa (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us j'�'
Identity the work covered by this request:
❑NEW ❑REMODEL ❑ADDITION ❑REPAIR�Qr�� °� �G���rW► � I ��1Q�� `
407 to 800 Ampere � $50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Ampere � $5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
GIRCUITS, CIRCUITS OF LESS THAN 50 V0�7S
Each S stem Device or aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Liahtina Retrofit � $25 oer Fi�Rure
Traffic Signal Standard � $5
Sup lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transfortner / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and�or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelfin Unit �$8t
Additional !ns ect+on Tri s � $20
Investi ative Fee
Reinsoection Fee � $20
{minimum total fee is
289i8
Ma�ufactured Home Park Lots �$25 � hereb ce ' that t inspeaed me eiec��a! inscal�ation described herein ar� me aa�s s��a.
R�reational Vehicle Park Sites � $5 '�1°' "' ��
Se rate Bondin Ins 'on �$20 � z -
S ial Ins ion �$30 r Hour "�tNBPE`"01 �A�
S �al fns ' n � $.31 r MNe � � ~a�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF COMPLETED WITHIN 18 MONTWS
FOR OFFICE USE ONLY
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Requ Date: Rough-in Inspection Required? Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ill Call
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! 4 You must call the inspec[or when readyl Date Ready:
I certi(y that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of tl� efecirical work at:
Job A ress (Street�x, or R� No.)�� Cit�r � rp Code
f �'c� �� 55�13�
Section Township pai
Occupant
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Power Supplier p�
E CoMracror/Compan Name
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M' Address (Co or, Company or Owner Perfoi
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Authori Si �ature (Contractor, Com or Owner F
E&WWtA-13 7/1l2000
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BOARD OF ELECTHICITY COPY
1 I'ti� _ J +
� Number Master License Number
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` 55�8�
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�NSTRUC�ION8 ON BACK OF YELLOW COPY