P - 79528REQUEST FOR ELECTRICAL INSPECTION
� _ � � � - � H � 0 � Minnesota Board of Electricity
�° 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�� �°' (651) 642-0800 TTY/M 1-800-627-3529
www.electricity.st te.�s
Identity the work covered tiy this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR • �
GENERAL FEES utdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to S00 Amoere d$50 Transformers u to 10 KVA �$10
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A ratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit (� $25
OTHER ADDITIONAL FEES
L' h6 Retrofit �$25 er Fixture
Center Pivot Irri ation Boom (�
Manufactured Home Park Lots �
Recreational Vehicle Park Sites �
Seoarate Bondina Insoection � $20
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unft �$8(
Additional Insoection Trips � $20
Fee
total fee is
iai ms ecnon � �au r nour � •�-- �•.� --.�-. o _. _ ./
ial Inspection � $.31 per Mile �` �r � /
IS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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I certify that I am th�CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work aF.
Job A� (;tr��x, or Route No.),� / ��` � Cily /� /) — Zp Cod`y e _��
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OccupaM
Power Supplier
Authoriz�
EB-00007A-13 7/1/2
No. County /r
U
Phone
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' �, � *` A_ Contractor License
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qnei Performing Installation) -
7
or Own Perfortning Installation)
BOARD OF ELECfflICRY COPY
Number
3 " <S / �J v7v I
INSTpUCIIONS ON BACK OF YELLOW COPY