P - 79607REQUEST FOR ELECTRICAL INSPECTION
1 �,� � � 7 0 °�, Minnesota Board of Electricity =
� � m'� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
. :,��� (651) 642-0800 TTYIMRS 1-800-627-3529 ,r �
www.electricity.state.mn.us 2'�j�f% ''
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IdentiTy the work covered by this request:
❑ NEW EMODEL ❑ ADDITION ❑ REPAIR � `,il��� UL J � — r ` ' � ' ° � v
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Ampere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 8Q0 Am re �$75 Transtormers over 10 KVA �$20
IRCUITS / FEEDERS Transformer / Power Su for Si ns I Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit (� $80
CIRCUITS, CIflCUITS OF LESS THAN 50 VOLTS Additional Ins ection Td s�$20
Each Svstem Device or Aooaratus �$.50 Investiaative Fee
Each Addftional Unit � $25
OTHER ADDITIONAL FEES
Lighting Retrofit � $25 per Fixture
Cemer Pivot Irrigation Boom � $40
Manufadured Home Park Lots �
Recreational VehiGe Park SRes � $
Separate Bonding Inspection � $20
Soecial Insoection � S30 oer Hour
total fee is
I herebv ceAHv that I insoecled tlre eleclrical insfallalion described herein on
FOR OFFICE USE ONLY
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�te: Rouph-in Inspection Required7 ❑ Yes � o Inspection Other Than Rough-In:
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�ITHIN 18 MONTH
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(/ You must call the inspector when ready! Date Ready:
i certify that 1 am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe electrical work at
Job Address (Street, Bqx, or Route No.) , City _� ,, Tip Code . _
I Power
I Etectrical Contractor /
l BLAlNE HTI
Nam� f�. `� �
_ �VE N.E.
��ner Performing Instt
mpa er Performing
No.
Phone
Master License
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EB-00007A-13 7/1/2000 BO D OF ELEC7AICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY