P - 81626REQUEST FOR ELECTRICAL INSPECTION
'1 � Minnesota Board of Electricity �
1!� V,4 8� 5 7 O ;� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. state. mn. us
Identity the work covered by this request �� r b � �_ ���
❑NEW QREMODEL ❑ADDITION EPAIR �
GENERAL F S utdoor Li htin Standard @$1
SERVICES I POWER SUPPLIES Traftic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above S00 Amoere �$75 Transformers over 10 KVA �$20
� Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLT;
Each S tem Device or A ratus �$.50
ADDITIONS TO THE GENERAL
MULTIFAMILY DWELLINGS PER UNI
3 to 12 UnRs �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Manufactured Home Park Lots
Recreational Vehicle Park Site
Mile
Transformer / Power Su I for Si ns ! Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Suppty up to 500 Amperes, Ail
Circuits and Two Inspection Trips Each Dwellin Unit �$80
Additional Inspection TriDS � $20
total fee is
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�R OFflCE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes No Inspectian Other Than Rough-In: ❑ Ready Now Q W(II Call
— O � You must call the inspector when readyl Date Ready: �� r;� � p
I certify that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
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Section Township Range Fire No. C unri
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P wer Su plier Address
EI rical Corrtractor / Company Name
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�ng Address (Contractor, Company or OWner erforming
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Authorized Sianatu alContractor. Comnanv n nwr Pwrfni
Phone
Contractor License
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EB-00001A-13 7/1/2000 � � BOARD OF ELECTHICRY COPY INSTpUC71pN8 ON BACK OF YELLOW COPY