P - 78292. REQUEST FOR ELECTRICAL INSPECTION `�
/� Minnesota Board of Electricity �
�� 3 6 8� O�`t 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 - -
www.electriciry.state.mn.us
Identity the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION 1REPAIR ��% � �� U� � � �.L`i I�J I 1..�-� ,
GENERAL FEES Outdoor Li htin Standard �$1 .
SERVICES / POWER SUPPLIES Tra(fic Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am re�$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transfortners over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su for Si ns / Outline Li Min �$5
0 to 200 Am re�$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit f� $80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri �$20
Each S stem Device or Ap aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE /�n,
3 to 12 Units �$50 Per Unit (minimum total fee is $20) �C{:ii�
Each Additb�al Unit � $25 F011N�0T0fl "� °NLY
OTHER ADDITIONA
Li htin Retroffi �$25 r Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots �$25 � nere certiy mat � inspected the e�ectrical installauon described herein on ihe dates srated:
Recreational Vehide Park Sites �$5 101�"" ��
Se rate Bondin Ins 'on � $20
S iel I ' n�$30 r Hour �TM"� "��10" opTE
S' In 'on (� $.31 r Mile e..� '•— v^
____ _ THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTH
FOR OFFICE USE ONLY
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Request Date: �7 Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now ill Call
����� �`-'j' You must call the inspector when readyl Date Ready:
I certiiy that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical wo�C at:
Job Address (Street, Box, or Route No.) City �p �p�
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Section Township L1 �y ire No. County
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Occupant Phone
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Power Supplier Address
EI� I CoMractor / Comp ny Na Co t aor License Number Mas r Licensey� m
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Mailin Address (Contrac[or, Company r Owner Perfortning Installallon)
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Authorized Sig ontra PeAortning Installation) Phone _����
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EB-00001A-13 /1/2000 BOApD OF ELECTRICRY COPY INSTRUCTIONS ON BACK OF YELLOW COPY