P - 78280�
REGlUEST FOR ELECTRICAL INSPECTION
1 ��� ��� Minnesota Board of Electricity
e � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
. (651) 642-0800 TTY/MRS 1-800-627-3529 -
www. electrici ty. state. mn. us
Identity the work covered by this request:
❑ NEW EMODEL ADDITION ❑ REPAIR /� � � p��, _ �
GENERAL FEES Outdoor Li htln Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal SYandard �$5 .
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Trans(ormers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am re � ONE & iW0 FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S stem Device or A ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$50 Per Unit (minimum total fee is $2
EaCh AddltlOf181 Unit �$25 r� ir�cTOn use aav
OTHER ADDITIONAL
Li htin Retrofd �$25 er Fixture �y �
CeMer Pivot Irri ation Boom (� $40
ManufaCtut2d Home Park Lots �$25 I hereb cert' that I inspected the electrical insfallation described herein on the dates siated:
Recreational Vehicle Park Sdes (� $5 '�011N ��
Se rate Bondin In 'on � $20 �— ��f
S ecial Ins ection �$30 r Hour ""'�'"�EOTq"' � ��
S ecial Ins ection �$.31 r Mile i^—�--��� '�+� �'`'('
THIS INSTALLATION MAY BE ORDERED DISCONNECTED NOT COMPLETED WITHIN �R �unNTUe _
FOR OFFICE USE ONLY ^ , , ���
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Request Date: Rough-in Inspection Required? es ❑ No Inspection Other Than Rough-In: ❑ Ready Now �NVill Call
��`'f �—Q L� You must call the inspector when ready! Date Ready:
I ceAify that I am the [�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
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Section Township � O Ran� Fire No. County
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Occupant Phone
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Power Suppli r Addr s � �� ���� O�
� Contractor License Number Master License Number
Electrical Contractor Company Name
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Maifing pddress (CoMrador, Company or Owner Performing Installation)
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Authoriz d S' (Contractar, C a or Owner Perfortning Installation) Phone �(��
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EB-00001A-13 7/1/2000 BOARD OF ELECTHICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY