P - 79499REQUEST FOR ELECTRICAL INSPECTION
1� 2 7 9� 2� 8 Minnesota Board of Electricity "°
P�� 1821 University Avenue Suite S-128, Saint R�ul, Minnesota 55104
. ��� �°� (651) 642-0800 TTY/MRS 1-800-6 29��
www.electricity.state.mn.us ��j
Identity the work covered by this request: �f7�
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
SERVICES I POWER SUPPLIES
0 to 400 Am ere �$25
401 to 800 Am ere �$50
Above 800 Am re � $75
CIRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus (� $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unii � $25
Center Pivot Irtigatlon Boom � $4C
Manufactured Home Park Lots � $
Recreational Vehide Park SRes �
Separate Bonding Inspection � 521
Soeciai Inspection � $30 oer Hour
Outdoor Liahtina Standard
Transformers u to t0 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Suppdy for Signs I Outline Lighfing �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$8(
Additional Inspection Trips � $20
Investiaative Fee
total fee is
the electrical installatbn described herein
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FOR OFFlCE USE ONLY
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Request Date: � Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-la: � � Ready Now ❑ Will Call
���� 0 2 You must call the inspecta when ready! Date Ready:
I cer�iy that I am the � LICENSEO CONTRAGTOR ❑ 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 Range Fire No. Counry
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Occupant � Phone
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Electrical CoMractor / Company Name
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Mailing Address (Contractor, Company or Owner Performing
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Authorized Signature (Contrador, Com any or Owner Perfoi
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Contractor License Number
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EB-00001A-13 � 7/1/2000 V U U BOARD OF EIECTfiIC17Y COPY
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Phone
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INSTRUCTIONS ON� BACK OF YELIOW COPY