P - 82466REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electriciry �"°�
• 1� O 3 O� 6 2 9 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 lTY/MRS 1-800-627-3529
www.electricity.state.mn.us
Identlfy the wark covered by this request: ��� �P�`y �����y � ��n���
EW ❑REMODEL ❑ADDITION ❑REPAIF
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES I POWER SUPPLIES Traffic Sianal Standard �$5
Above 800 Ampere (� $75
;UITS ! FEEDERS
0 to 200 Ampere � $5
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTROL,
:UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus � 5.50
ditional Unit � $25
OTHEF ADDITIONAL
Retrofit � $25 cer Fixture
as �
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Transfortners u to 10 KVA �$10
Transfortners over 10 KVA (� $20
Transformer / Power Supply for Signs / Outline Lighting �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, AN
Circuits and Two Inspection Trips Each Dwellin Unit �$8(
Additional Insoection Trins � $20
Fon
Fee �
total fee is
Special Inspection �$.31_ per Mile � �D' L6r °'C� I
THIS INSTALLATION MAY BE ORDER�D DISCONNECTED OT COMPLETED WITHIM 18 MONTHS
FOR OFFlCE USE ONtY
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Olher Trian Rough-In: Ready Now � Will Call
3' Q Q You must qll the inspector when reacfy! Date Reatly:
! certiiy that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of tl�e electrical work ffi:
Job Address (Street, Box, or e No.) City - Zp Code
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IOccupant
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iny or Owner PeHo�
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EB-00001
Phone
License
BOAAD OF BLEC�RICITY COPY
Master License
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Phone
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INSiRUCTTONS ON BACK OF YELLOW COPY