P - 81942REQUEST FOR ELECTRICAL iNSPECTiON
1 Minnesota Board of Electricity '-Y
�' 1-13 5- 5 61 ���; (651) 642 OS00 ATTY/MRS11 00 627 3529Paul, Minnesota 55104
www.electricity.state.mn.us '
Identity the work covered by this �equest: �
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR (�(/ l.X. � Lr � ( � �
GENERAL FEES utdoor Li htin Standa �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$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
RCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service andlor Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Tri s Each Dwellin Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Insoection Trips �$20
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
_TIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Lighti�g Retrofit � $25 per Fixtura
Center Pivot Irrigation Boom � $4(
Manufactured Home Park Lots � $
Recreatlonal Vehicle Park Sites �
I herebvi ceAifv that I insoected the electrical installatlon
FOR OFFICE USE ONLY
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R����sl� Rough-in Inspection Required? ❑ Yes Inspection Oth
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� You must call tlie inspector when ready! Date Ready:
I certiTy that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and
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Address
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ctor / Company Name
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(Contractor, Company or Owner Pertorminc
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total fee is $2o v
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request inspection of the electrical work at
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I Authorized SignSture ( oMractor, Com y or Own�'PeAortning Installatian) I Phone� ^' �,� ^ �
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EB-00001A-13 7/1/2000 � BOARO OF ELECTRICfTV COPY INSIAUCTIONS ON BACK OF YELLOW COPY