P - 79590REQUEST FOR ELECTRICAL INSPECTION
1 17�4 9 O 8 °� e Minnesota Board of Electricity
� � �� � 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 coveretl by this request: � t, � R
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❑ NEW ❑ REMODEL ADDITION ❑ REPAIR GL/��.+` dl ���:�11� �6Ds� 7�r� ..J nn
/' 0 to 400 Am ere �$25 Z,,, n, J�
401 to 800 Am ere (� $50 —°��
Above 800 Ampere � $75
CIRCUITS / FEEDERS
0 to 200 Am re �$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit (� $25
Lighting Retrofit � $25 per Fature
Center Pivot Irrigadon Boom � $4(
Manufactured Home Park Lots � 9
Recreadonal Vehicle Park Sites �
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° Outdoor Li htin Standard � $1 "
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transfortner / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELIINGS, EACH UNIT
Includes the Service and/or Power Supply up to 5� Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$8(
Additional Inspection Trips � $20
Investigative Fee
Reinscection Fee � $20
I
total fee is
� � Special Inspection �$.31 per Mile � � ( %"` �`""'I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Request Date• Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now Cell
D�� You must call the inspector when ready! Date Ready:
I certify at I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecction of the electrical work at:
EB-00001A-13 7/1l2000 BOARD OF ELECTHICRY COPY INSTRUCTIONS ON BACK OF YELLOW GOPr