P - 79704� REQUEST FOR ELECTRICAL INSPECTION
/� % °< � ; Minnesota Board of Electricity �"° �
1� 218 �`t � 1 =�� s �821 University Avenue Suite S-128, Saint Paul, Minnesota 104
„K� � �e< (651) 642-0800 TTY/M RS 1-800-627-3529 � �
www.electricity.state.mn.us � V\�
Identity the work covered by this request:
❑NEW EMODEL ❑ADDITION ❑REPAIR � �l— / �pUJ
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES ! POWEF SUPPLIES Traffic Si nal Standard (� $5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
IRCUITS / FEEDERS Transfortner / Power Su I for Si ns / Outline Li hN �$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 Inves6 tive 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 $20
EaCh Additional Unit �$25 ��ECTIXi USE ONLY
Center Pivot Irrigation Boom � $
Manufactured Home Park Lots �
� $.31 oer Mile
I hetebvi ceNN tl�at I
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FOR OFFlCE U8E ONLY
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Re est Date: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now �I Call
`��J � You must call the inspector when readyl Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ 60MPANY ❑ OWNER and hereby request inspection of the eledrical work at
Job Address (Street, Box, or Route No.) _ _ CiNr� e_ Zip C�de _,
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EB-OOOOtA-73 7/1/2000 BOARD OF ELEC7AICRV COPY INSTAUCiIONS ON BACK OF YELLOW COPY