P - 81664REQUEST FOR ELECTRICAL INSPECTION
1 � � 0 � � � ° � Minnesota Board of Electricity —
�. � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� ' � �� �' (651) 642-0800 TTY/MRS 1-800-627-3529
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www ctricity.state.mn.us
Identity the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION � � C CC/
GENERAL FEES Outdoor Liohtina Standard �$1
0 to 400 Am ere �$25
401 to 800 Am ere �$50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNlCATION, REMOTE CONTROL, SlGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Add'Rional Unit � $25
OTHER ADDITIONAL FEES �
L' hti Reirofit � $25 Fixture
Center Pivot Irri tbn Boom �$40
Manufactured Home Park Lots � $25
Recreafional Vehide Park Sites � $5
Seoarate Bondina Insoection � $20 _ _
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers up to f0 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / OuUine Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dweliin UnR �$8(
Additional Inspection Trips � $20
� Investiaative Fee
I hereby certilv that I
total fee is
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF'liOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Reque Data!� ` Rough-in Inspeclion Required? ❑ Yes ❑ No Inspection Oqier Than Rough-In: Ready Now' �- WIII Call
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You must call the inspector when readyl Date Ready:
I certity that I am the �L.ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe electrical work at
Job dr t, Bo or Route �� � City � � Zp I I
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Sedion ownship �^ Flan� Fire No. Cou
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Power upplier /1 � Adtlress
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EB-00001A-13 7/1/2000
�ny Name cen�
�LECT�►C, INC.
C�p�y �D�erAahrming Installation)
S ils IYa 1\ n
MN 433
, omp Owner P f ing Installation)
BOARD OF ELECTRICRY COPY
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ON BACK OF YELLOW COPY