P - 78318REQUEST FOR ELECTRICAL INSPECTION
Q Minnesota Board of Electricity °��
1��3 4 7�� V� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 =
. www.electricity.state.mn.us
Identi(y the work covered by this request: n n? L? v
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR �C� f�"
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 800 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am ere (� $75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer I Power Su for S� ns / Outline Li htin �$5
0 to 200 Am re �$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Inciudes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGN LING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S stem Device or ratus �$.50 Investi Gve Fee
ADDITIONS TO THE GENERAL FEES Rein 'on Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$50 Per Unit (minimum total fee is $20) �� .S
Each Additional Unit � a25 '�"'"�CiOP � °NL`'
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fixture
CeMer Pivot Irri tion Boom �$40
ManufaCtured Home Pafk Lots �$25 I hereby ceR' that I ins ed the electrical installation described herein an the dates sfated:
Recreational Vehi�e Park Sdes � $5 �"'" �"�
S rate Bondin I ion �$20
S ial In ion �$30 er Hour """""��'b" o^T� �/
S �al Ins 'on �$.31 r Mile c� �'�r
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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R t ate: Rough-in Inspection Required? Yes ❑ No Inspection Other Than Rou h-In:
g ❑ Ready Now Will Call
� You must call the inspector when readyl Date Ready:
I certify That I m the ❑ LICENSED CONTRACTOR ❑ COMPANY OWNER and hereby request inspection of the electrical work at:
Job/lddress (Street, Box, or�ute No City j Zip Code
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Section Towns ip Range County
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Mailing Address (Contrador, Company or
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Autharized Signature (Contrador, Compai
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EB-00001A-1 7/1
Perfortning Ins1
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BOAND
License
COPY
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Master license Number
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INSTqUC710N$ ON BACK OF YELLOW COPY