P - 782371-44�-430 �
❑ NEW ❑ REMODEL ADDITION ❑
GENERALFEES
SERVICES I POWER SUPPLIES
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TlY/MRS 1-800�27-3529 www.electricity.state.rme.us
� Describe -using the back of the white copy 'rf necessary - the work covered by this request:
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Exh System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
3 to 12 U�its �$50 Per Unit
Each Additional Unit @ E25
LighGng Retrofit @ $.25 per Fixture
Cenler Pivot Irtigation Boom @ yK
Manufaclured Hane Park Lots � j
Recrea6on� Vehicle Park Sites �
�� 11 �I II� II III IIIII IIIII I�III IIIII �� I�
L4484307
Su lemental Fee $20
Transformers up to 10 KVA @$10
Transformers over 10 KVA $ 20
Transfamer / Power Su I fa Si ns I Outline L' htin ES
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellirg Unit @ S80
Additional Inspection Trips @ S20
Irnestioative Fee
(minimum total fee is $20) � ���'J �=
THIS AREA Fp21NSPECTOR USE ONLY
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NOT CO PLETED WITHIN ON'
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�. ruwgn-m �nspecryon Required? ,�I Yes ❑ No Irspedion Other Than
O r
You must call the inspector when ready! pa(e Ready:
I am Uie �LICENSED CONTRACTOR ❑COA�ANY ❑ OWNER and hereb �
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Now ❑ Wfll Call
inSPecfion of the elec6ical work at:
EB-00001A-14 8.1.2002