P - 81625REQUEST FOR ELECTRICAL INSPECTION
"� � � � � � � � � ` a 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 covered by this request: [f �
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❑ NEW ❑ REMODEL ❑ ADDITION REPAIR � �
GENERAL FE S Outdoor Li htin S d d�$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to S00 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns ! Outline Li htin �$5
0 to 200 Am ere �$5 � i � ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unft �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Inspection Tri �$20
Each Svstem Device or Aooaratus �$.50 Investlaative Fee
OTHER ADDITIONAL FEES
Lighting Retrofit � $.25 per Fixture
Center Pivot Irrigation Boom � $40
Manufactured Home Park Lots � $2
Recreational Vehicle Park Sites � $�
5eparate Bonding Inspection � $20
Special Inspection � $30 per Hour
5pecial Inspection � $.31 oer Mile
tota! fee is
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I herebvi certiN that i insoected the electrical installation described herein on Ure c�tes stated:
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FOR OFFlCE USE OIdIY
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Request Date: � Rough-in Inspec6on Required? ❑ Yes �'P�lo Inspection Other Than Rough-In: ❑ Reedy Now ❑ Will Call
�"�� Q�i You must call tlie inspector when ready! /" Date Ready: �� I "� �
I certi(y that I am the�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elechical work at
Job � ress (Street, Box, or Route No.) City� Zip Code
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Section Township Range Fire No. Co ty
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il Contrador / Company Name
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Address (Contractor, Company or Owner Per
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EB-00001A-13 7/1f2000
Phone
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CoMractor License
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BOARD OF ELECTRICRY COPY
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INS'IAUC710NS ON BACK OF YELLOW COPY