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Identi(y the work cove�ed y this request:
❑NEW REMODEL ❑ADDITION ❑REPAIR
REQUEST FOR ELECTRICAL INSF't(;1 IUN
Minnesota Board �rf Electri�iry
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us ��G1�'� � ���
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Outdoor Lighti� Standard � $1
SERVICES I POWER SUPPLIES � Trattic Sianal Standard �$5 .
0 to 400 Ampere (� $25
401 to 800 Ampere � $50
Above S00 Ampere � $75
CIRCUITS / FEEDERS
to 200 Ampere (� $5
Above 200 Ampere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofit �$.25 per Fixture
Center Pivot Irti ation Boom �$40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites � $5
Se arate Bondin Ins ection �$20
Soecial Insoection � $30 oer Hour
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Transfortners u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Supply for Sipns / Outline Lighting �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dweilin Unit �$8[
Additional Inspection Trips � $20
Investiaative Fee
total fee is $20) �°1�� ��
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I hereby certify that I ins the eleclrical installation desCri�er9i o tA� dates stat�:
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED
FOR OFFICE USE ONIY
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Request te: Rough-in Inspectfon Required7 ❑ Yes � No Inspection Other Than Rough-In: �,_] Ready Now� Wili Call
���/(�S` You must call the inspector when ready! Date Ready:
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY �OWNER and hereby request inspection of the electrical work at:
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Job Address (Sireet, Box, or Route No.) City Zip Code
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Seciion Township Range Fire No. County � �
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Occupant Phone
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Power Supplier . , _ Address /1 �
Eleclrical Coniractor /
Mailing Address (Con
Authorized Signature
EB-00001A-13 7/1/2000
or Owner Performing Installation)
or
BOAHD OF ELECTRICRV COPY
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Master License Number
Phone I
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INSTRUCTIONS ON BACK OF YELLOW COPY