P - 79565REGlUEST FOR ELECTRICAL INSPECTION
1�-61 3� q. g'; Minnesota Board of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
f ?��° (651) 642-0800 TTY/MRS 1-800-627-3529�'
www.el ctricity.state.mn.us
Identity the work covered 6y this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR , � �
GENERAL FEES Outdoor i htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA C� $20
CIRCUITS / FEEDERS Transfortner / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNAUNG Circuits and Two Inspection Trips Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri d$20
Each S stem Device or A ratus �$.50 Investioatnre Fee
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofd �$25 er Fixture
Cemer Pivot Irri ation Boom �$40
Manufactured Home Park Lots � $25 �..
Recreational Vehicle Park Sites �$5 e
that I insoeded the eleclrical
total fee
� � Special Inspection �$.31 per Mile � � ( �/� --�= l"��I
THIS INSTALLATION MAY BE ORDERED DISCONNECT'ED IF OMPLETED WITHIN 18 MONTHS
— _ FOR OFFICE USE ONLY
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Reque Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection O[her Than Rough-In: Ready Now ❑�II Call
�O You must call the inspector when readyl Date Ready:
I certi(y that I am the�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Address (Street, . o Route No.) . �/ n � . /� � Zip Code I / _ -
I • � / _ � . / /
Section Township
Occupant
Power Supplier
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�io� `�ip s `�
AuUw�ized si
EB-00007A-13 7/t/2000
Address
Fire No.
Phone
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BOARD OF ELEC7AICRY COPY
Number 1 Master License Number
Phone
' /S l ' J Z�'�J I
INSTRUCTONS ON BACK OF YELLOW COPY