P - 79642REQUEST FOR ELECTRICAL INSPECTION
-1 2 2 5 4 5 6 '` Minnesota Board of Electricity
� � � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�; (651) 642-0800 TfY/MRS 1-800-627-3529
www.electricity.state.mn.us " '
Identify the work covered by this request:
G7�NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 7ransformers over 10 KVA (� $20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
010 2� Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$SO
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional In ction Tri s�$20
Each S stem Device or A aratus (� $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$50 Per Unit (minimum total fee is $20)
EaCh Additional Unit � $25 PoP ����� �E ��y
OTHER ADDITIONAL FEES �,�T..�' 7—J Z' �'z g5 , S
Li htin Retrofit �$.25 r Fixture
Center Pivot Ir' tion Boom �$40 �j ..� "'�L��'
Manufadured Home Park Lots �$25 I hereb cediy that I ins d the electdcal installatbn described herein on e dates s�ed:
Recreational Vehicle Park Sites � $5 � "a'�"'" ,�7 ��
Se rate Bondin Ins ection ��20 �� 2 z—. v L
S ecial In ion �$30 r Hour """"�TON �'�
S ecial In ion �$.31 r Mile � � g�
THIS INSTALLATION_M_AY BE OROERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ Ready�Now ❑ Will Call
,,,� �� You must call the inspector when ready! Date Ready:
i certify that am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) Ciry Z�P �e
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Section Township Range Fire No. Co
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Occupant PFrone
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Power Supplier Address
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Electrical Contractor / Company Name CoMract r License Number Master License Number
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Mailing Address (Contractor, Company or Owner Perfortning Installation)
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Authorized Signature (Contrector, Company or Owner Pertorming Installation) Phone
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EB-00007A-13 /2000 BOARD OF ELECTHICT' COPY INST(iUCTONS ON BACK OF YELLOW COPY