P - 79899_ � � ,
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity '�
�� 2 2 2- 2� 9 �, 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-08�� TTY/MRS 1-800-627-3529
www.electricity.state.mn.us '' '
Identify the work covered by this request:
NEW ❑REMODEL ❑ADDITION ❑REPAIR �"�O i3 �d � — ! � 7 — H�S�
GENERAL FEES Outdoor Li hti Standard �$1
SERVICES / POWER SUPPLIES Traific Si nal Standard �$5
0 to 400 Am ere �$25 � Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUI7S / FEEDERS Transformer / Power Su I(or Si ns / Outline Li hti (� $5
0 to 200 Am re �$5 ONE & TWO 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 Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S stem Device or A aratus �$.50 Investi ative Fee
ADDITVONS TO THE GENERAL FEES Reins 'on Fee �$20
MULTIFAMILY DWELLINGS PER UNI ,� __ TOTAL FEE
3 to 12 Units �$50 Per Unit � i im tOtal fee is $20)
Each Additional Unit � $25 w"'"s�E`'T°" "s� °""
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OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fixture ��,:
Center Pivot Irri ation Boom �$40 h (.v�
Manufactured Home Park Lots �$25 I hereby certify fhat I inspected the elechical installation described hevre� on tice dates srated:
Recreational Vehicle Pa�k Sites �$5 R01`'"'" �j D°�
Se arate Bondin Ins ection � $20 ` ' � `� �'
S ial Ins ection �$30 r Hour hNqLN3PE0T0N °�'�
S'af tn ection �$.31 r Mile ��'� �" �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE 13SE ONLY
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Request Date: Rough-in Inspectan Required? es ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
����— You must call the inspector when ready! Date Ready:
I certify that I am th ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) C'dy Zp Code
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Section Township Range Fire No. Cou
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OccupaM Phone
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Power Supplier Address
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Electrical Contractor / Company Name Contractor License Number Master License Number
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Mailing Address (CoMractor, Company or Owner Perfortning Installation)
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Authoriz Si ture (Contracto pany r ner Performing Installation) Phone
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EB-00001A-13 7/7/2000 BOAHD OF ELECTRICITY COPV iNSTFiUCT10NS ON BACK OF VELLOW COPY