P - 79740. REQUEST FOR ELECTRICAL INSPECTION
1�`t O�-� 19 �6 Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
y (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION ❑�EEPAtt� Describe -using f�e back of the white copy if necessary - the work covered by this request:
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
E�h Addifional Unit @ $25
OTHER ADDITIONAL FEES
Li htin Retrofit $.25 er Fixture
Center Pivot Irriaation Boan �1$40
Hour
Mile
dSTALLATION MAY BE ORDEF
IIIII Iilll lllll IIIII IIIII IIIII ll(I Iilll ��1�
1 4 0 L 8 1 9 6
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns I Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes tl�e Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dweliing Unit @$80
Additional Ins tion Tri s $20
Inves6 ative Fee
Reins ction Fee $20
TOTAL FEE
(minimum total fee is $20)
THIS AREA FOR 1I�LSPELTOR USE OKY
I hereby cer6y that I inspected the elec6ical i�sGlla6on described herein on ttie dafes sUOed:
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspeqion Other Than Roug Now ❑ Wpl Call
You must call the inspedor when ready! Date Ready:
I certifythat I am tlie�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspeclion of the electrical work at:
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INBTRUCTONS ON BACK OF YElL9rPL`O�Y " BOARD OF ELECTRICITV CAPV � EB-00001M14 8.1. 2002
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