P - 81683REQUEST FOR ELECTRICAL INSPECTION
' Minnesota Board of Electricity —
�� V 1�- 4 6 0 �' 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�� ��° (651) 642-OS00 TTY/MRS 1-800-627-3529
www.el tr.ic,l�tate.mn.us
Itlentity the work covered by this request:
❑NEW ❑REMODEL ❑ADDITION ❑REPAIR (
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am ere �$25
401 to S00 Am ere �$50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am re �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus �$.50
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Manufactured Home Park Lots �
Recreational VehiGe Park Sites �
� `%U,�rl . �.�cQ�ICG
Outdoor Li htin Standard � $1
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su i for Si ns / Outline Li htin �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Ins ection Trips Each Dwellin Unit �$8C
Additional In ion Tri s�$20
Investi tive Fee
Reinscection Fee � $20
I insoeded the electrical installa�on
total fee is
Special Inspection � $.31 per Mile � � — � � 3 � �
THIS INSTALLATION MAY BE ORD�RED DiSCONNECTED IF T COMPLETED WITHIN 18 MONTHS
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_ FOA OFRCE I�E ONLY � ��
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Req Date: i � Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: eady Now 0 Will Ca0 �
' �UVou must call the inspector when readyl Date Ready:
I certi(y that i am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work ai
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EB-00001A-13
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MSTfiUCTIONS ON BACK OF YELLOW COPY