P - 80083REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity �
1� 3�7 � 5 3 5 ��' 1821 University Avenue Suite S-128, Saint Pau Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 ���'
www. electri city. state. mn. us
Identify the work covered by this request:
❑NEW EMODEL ❑ADDITION ❑REPAIR C S1 �� ��� 6 U�S
GENERAL FEES Outdoor Li htin Standard �$t
0 to 400 Ampere � $
401 to 800 Ampere �
Above 800 Ampere �
u to zuu nmpere �e �o � Vv� � ' • � � '
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTROL, SIGI
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
LigMing Retrofit � $25 per Fbcture
CeMer Pivot Irrigation Boom � $4(
Manufactured Home Park Lots � $
Recreational Vehicle Park Sites (�
Traffic Si nal Standard @ $5
Su lemental Fee � $20
Transformers u to 10 KVA (� $10
Transformers over 10 KVA (� $20
Transformer / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$SO
Additional Inspection Trips � $20
Investiaative Fee
total fee is
I inscected the electrical insqlladon described
� � Special Inspection �$ 31 per Mile I I L �'� < °''� "� `�
THIS INS7ALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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RequesJ�ate: Rough-in Inspectbn Required? ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now iH Call
p��D � You musi catl the inspector when readyl Date Ready:
I certi(y� that I am the �CENSED CQNTflACTOR ❑ GOMPANY ❑ OWNER and hereby request inspec6on of 1he electrica� work ak
Job �ddr�� Sh�eet, Bo�� Ro No.) � �� City��� Zip Code „� �
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Power Supplier
Electric�l �k3CbrJL
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Mailing Address
Authorized � ture (
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EB-00001A-13 7/1/2000
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:LECT.. !�!C.
AVE. N.E.
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BOAiiD OF ELEC7AICRY COPY
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INSTFiUC71ON8 ON BACK OF YELLOW COPY