P - 77289REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electriciry °'�
1� 3 4 7- 4 91 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn. us
Identify the work covered by this request:
❑ NEW ❑ REMODEL DDITION ❑ REPAIR Q"l, �
GENERAL FEES Outdoor Liahtina Standard � S1
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transfortners u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS I FEEDERS Transformer / Power Su for Si ns / Outline Li htin �$5
0 to 200 Am re �$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIFCUITS OF LESS THAN 50 VOLTS Additional In ion Tri �$20
Each S stem Device or aratus �$.50 Investi aGve Fee
ADDITIONS TO THE GENERAL FEES Reins ectio� Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to �2 Uni� �$5o Per Unit (minimum total fee is $20)
Each Additional UnR � $25 `O"'"�0T0" "� °NLV
OTHER ADDITIONAL FEES
' Min Retrofit � $25 r Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots �$25 � nereb cerory mat I inspected tl,e electrical insra�latlon described nerein on me dates stated:
Recreatlonal Vehicle Park Sites �$5 P01G"'" °"T�
Se arate Bondin Ins 'on �$20 � i� ��
S'al Ins ion �$30 r Hour """""�"E�"�' / °"'�
� In ' � $.31 r Mile �O ` � �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN #b MONTHS
FOR OFFICE USE ONLY �'�
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I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY �bWNER and hereby request inspection of the electrical work at:
Job Address (St�. Box. or Route No. sl�� C�ty �� // Zip��� �
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Section Township Range Fire No. County
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Power Supplier Address
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Electrical Contrador / Company Name
Mailing Address (Contrador, Company or Owner Pertorming
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Authorized S' ure (Contractor, Compan ner e i
EB-00001A-13 7/1
Contrec[or License Number Master License Number
Installation)
ning I ation) Phone
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BOARD OF ELECTRICITY COPY INS'TFIUCTIONS ON BACK OF VELLOW COPY