P - 79637REQUEST FOR ELECTRICAL INSPECTION
�4 �� Minnesota Board of Electricity °°�
1�+l � q. � 8 7 1 ? 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
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��� e'� (651) 642-0800 TTY/M RS 1-800-627-3529
www.electricity.state.mn.us " '
Identify the work covered by this request:
NEW ❑REMODEL ❑ADDITION ❑REPAIR NQ� r{/► �k.�p�' � CL
GENERAL FEES Outdoor Liahtinq Standard �$t
0 to 400 Am ere �$25 ���
401 to S00 Am ere �$50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am ere (� $5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus �$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
U htin Retrofd �$25 r Fature
Center Pivot I' ation Boom �$40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites � $5
Se arate Bondin Ins ection �$20
Soecial Insoection � S30 cer Hour
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transfortners over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$SO '�
AddRional Ins ection Tri s�$20
Investiaative Fee
FOR OFFICE USE ONLY
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total fee is
described herein ai the dates sta�:
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I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecction of the electrical work at
Job Address (Street, ox, or Route No.) City Zip Code
(v(J Cl,e� S � �'�� l� S�'�f3 �.
Section Township _� Ran_ e� Fire No. Coun/��'OIYJ/� �
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Power Supplier �
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Electrical Contractor / Company Name
Gi � I�.r ��i
Mailing Address (Contractor, Company or Owner
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Authorized Signa re tractor, Com ny or
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EB-00001A-13 7 1/2000
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;+I Phone
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BOAAD OF ELECTRICITY COPY
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INSTRUCilON3 ON BACK OF YELIOW COPY