P - 79569REQUEST FOR ELECTRICAL INSPECTION
1 � � � � � � � Minnesota Board of Electricity "� .�
� � �' y� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� �� �� (651) 642-0800 TTY/MRS 1-800-627-3529
www.electriciry.state.mn.us �/��,,� '� '
Identify the work covered by this request: ���'� J�� �'�'�� /�i�jr,� �"�o� ��" ,
❑ NEW ❑ REMODEL ❑ ADDITION �REPAIR/��/ rf'��`��������� ��/ //���
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIR UITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin (� $5
0 to 200 Am ere �$5r°—�tC r' ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$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 Unit �$80
CIRCUITS, CIFiCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20
Each S stem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$2�
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$50 Per Unit (minimum total fee is $20)
Each Additional Unit �$25 wp ����T� USE ONLV
OTHER ADDITIONAL FEES
Li htin Retrofit (� $25 r Fixture
Center Pivot Irri ation Boom �$40
Manufactur8d Home Park Lots �$25 I hereb certi(y that I inspected Me electrical instailatian described herein on the �tes staied;
Recreationai Vehicie Park 5ites �$5 "01°"'" 0A1E
Se arate Bondin Ins ection �$20 ,� �' o
S ial Ins ection �$30 r Hour 4 _ RNAI INSPEC710N o�,�
S ial Ins ection �$.31 er Mile v Q� � c
THIS INSTALLATION MAY BE ORDERED DISCONNECTED F NOT COMPLETED WITHIN 18 MONTHS
FOR OPFICE USE ONLY
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Reque Date: Rough-in Inspection Required? Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now WIII Call
�'p� You must call the inspector whe re y! Oate Ready:
i certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work ai
Job Ad ress (St eet, , or Ro No.) City tp Code
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ailing Address (Contrador,
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EB-00001A-73 7/1/2000
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or Owner Performing Installation)
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BOARD OF ELEC7RICITY COPY
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Number � Master License Number
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INSTRUC710NS �1 BACK OF YELLOW COPY