P - 79860REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity �
1�� g 2� 5 6 O � e 1821 University Ave�ue Suite S-128, Saint Paul, Minnesota 55104
�a� °: (651) 642-�800 TTYfMRS 1-800-627-352 �-
www. electrici ty. state. mn. us
Identify the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR �� �' 1 � �L�� ��Z �
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 ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA (� $20
CIRCUITS / FEEDERS Transformer / Power Su I ior Si ns 1 Outline Li htin �$5
0 to 200 Am re �$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 Dwelli Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional ins ection Tri (� $20
Each S stem Device or A aratus �$.50 investi tive Fee
A�DITIONS TO THE GENERAL FEES Reins 'on Fee �$20
MULTIFAMiLY DWELLINGS PER UNI TO7AL PEE c
3 to 12 Units �$50 Per Unit (minimUfn tOtal fee iS $20) �
Each Additional Unit �$25 � MSPECTOH USF ONLY
_ OTHER ADOITIONAL FEES 2 9 b� ,t
Manufactured Home Park Lots � g
Recreational Vehide Park Sites �
Separate Bonding Inspection � $2�
Soecial Insoection � $30 cer Hour
I herebv certilv that I inspected tlre
FOR OFFICE USE ONLY
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I certify that I am the CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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Occupan� � �� Phone
Power � �� � ress �
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Elect�ritractoy/.�omp�y N L e �� ` /� Contractor License N�
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Mailiqg /�drg,ss (�onhactor, Company or Owner Perfomyng In�tallation) „ �
Aithorized S/gnature (ConVactof, Company o ner Performing Installation)
EB-00001A-13 7/1/2000 BOMD OF ELECTRICITY COPY
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