P - 81798REQUEST FOR ELECTRICAL INSPECTION
�10 5 O 7 7 � Minnesota B�ard of Electricity
�� � �� 1821 Universi Avenue Suite S-128, Saint Paul, Minnesota 55104 `:�
n?� :°°� (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us
identify the work covered by this request: ���
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR �
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere C� $25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above S00 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS I FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am re �$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service and/or Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additbnal Ins eclion Tri �$20
Each S stem Device or A aratus �$.50 Investi tive Fee
ADDITIONS 70 THE GENERAL FEES Reiasaection Fee �$20 __
�
OTHER ADDITI01
� 5.25 oer Fixiure
I herebv certilv that I
� $30 per Hour
� $.31 oer Mile
total fee is
herein on tlre dates sta4ed: I
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FOR OFFlCE lIBE ONLY
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Reque Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspecdon Otlier Than� Rough-In: Ready Now ❑ Will Call
�' � You must rall the inspector when readyl Date Ready: � �
I certify that I am the�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Address (Street, Bo�,1�cQgute No.) � City ��_ Zp Code �
Range � Flre No.
� OccupaM
PFwne /
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ElectriD�p=�oDABLEyELECTRIC. INC• CoMr ctorLicens
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Maili ( A or, o rfortning Installetion)
C�on Rapids, N 554
AuUiorized Signature hactor, Comparry or Owne PeRortning Insteltationj
EB-OOOOtA-13 7 BOARD OF ELEC7AICT/ COPV
License
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