P - 81889_ REQUEST FOR ELECTRICAL INSPECTION
1 � � � � � � � , Minnesota Board of Electricity
� � 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
z� '�� (651) 642-0600 lTY/MRS i-800-627-3529
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www.electricity.state.mn.us
Identity the work covered by this request: �.r;Ly _+_ ��Y�S � r'"�'
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❑NEW ❑REMODEL ❑ADDITION REPAIR L�}�4'�✓�C� G� �L.�,�..�� �—�l C__
0 to 400 Ampere � $25
401 to 800 Am re �$50
Above 800 Ampere � $75
CIRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CiRCUITS OF LESS THAN 50 VOLTS
Each S em Device or A ratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units (� $50 Per Unit
Each Addftional Unit � $25
Lighting Retrofit � $25 per Fixture
Center Pivot Irrigation Boom � $4f
Manufactured Home Park Lots � $
Recreadonal Vehicle Park Siloc �.
ipecial Inspection � $.31 per Mile
THIS INSTALLATION MAY
OuMoor Li htin Standard � $1
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Trans(ormers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li htin �$5
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 �$8(
Additional Ins ection Tri s�$20
Investi ative Fee
Reinsoection Fee � $20
total fee is
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FOp OFFlCE USE ONLY
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Request D te: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: Ready Now � Will Call �
I � 5' ��� v . You must call the inspector when readyl Date Ready:
, 1 certity lhat I am the LICENSED CONTRAGTOR ❑ COMPANY ❑ OWNER and hereby request inspection of She electrical wak at
Job Address (Street, Box, w Route No.) Ciry Zip Code
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Section Township Range Fire No. Co
Power Supplier
e rical Contr�ctor / Compan�N e
Mailing Address (ConVactor, Company or Own
AutFwrized Signature (Contractor, mpan�o�
EB-00001A-13 7/1/2000
Phone
u�se
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License
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MISTRUCTIONS ON BACK Of YBLLOW COPY