P - 78465REQUEST FOR' ELECTRICAL INSPECTION
1 3 7 0' 6 4 2 a Minnesota Board of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� (651) 642-0800 TTY/MRS 1-800-627-3529 =
Q5 www.electriciry.state.mn.us
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Iden rk covered by is request:
❑REMODEL ❑ADDITION ❑REPAIR � J�
GENERAL FEES Outdqor Li hfin Standard �$1
SERVICES I POWER SUPPLIES Traific Si nal Standard �$5
0 to 400 Am ere �$25 Su lemeirtal Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transfortners over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Oudine ' hti �$5
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each Additional Unit � $25
OTHER ADDITIONAL
Lightirg Retrofit � $.25 per Fature
Center Pivot Irrigation Boom � $40
Manufactured Home Park Lots � $25
Recreational Vehicle Park SNes � $5
Seoarate Bondina Insoection � $20
ONE � TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$8f
Additional Ins ection Tri s�$20
Invesli ative Fee
Reins ion Fee � $20
TOTAL FEI
(minimum total fee is $20
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I herebv certi(v t4et I inspected the electrical installafion descxibed herein on tl�e
THIS INSTALLATION MAY BE ORDERED DISCONNECTED fF NOT COMPLETED WITHIN 18 MONTNS
FOR OFFICE USE ONLY
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Reque D te: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will CaN
� J You must call the inspector when readyl Date Ready:
I certiiy that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work ffi:
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EB-0OOOtA-13 7/1/2000 BOAIiD OF ELECTRICITY COPY � MISTRUCTONS ON BACK OF Y�