P - 79776� REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity �
1-396-554 � 1821 University Avenue Sulte S-128, Saint Paul, Minnesota 55104 `- :
� (651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity.state.mn. us
IdentiTy the work covered by this request:
d IVEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am ere �$25
401 to 800 Am ere �$50
Above S00 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Amoere � $5
AIARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL
TIFAMILY DWELLINGS (PER UNI�
3 to 12 Units �$50 Per Unit
Each Additionai Unit � $25
OTHER ADDITIONAL FEES
Lighting Retrofit � $25 per Fixture
Center Pivot IrriAation Boom � $40
Mile
X(�L EhiEROY SAVEF�S SWiTCH
Transformers over 10 KVA � $20
Transformers / Power Supply for Signs / Outline Lighting �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unft �$80
Additional Inspection Trips � $20
I�vesti ative Fee
Reinspection Fee � $20
TOTAL FEE
(minimum total fee is $20)
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I hereby cerU�y Mat I inspectetl tne eleclricel ins[alletan describetl herein on Me detas i
ROUGN M . DATE
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FOR OFFICE USE ONLY
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Reques� ��/Q'2 Rough-in Inspectlon Required? ❑ Yes �No Inspection Other Than Rough-in: �Ready Now ❑ wll Call
You must call the inspector when ready! Date Ready: �
I ce�ify that 1 am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Jab AddressiSise�t, Borp�.Ro�taAlo.1 .. � City �'� Zip Code ��,�.Z
�3J MCMVKT LIY
Section Township Fange Fire No. Counry �(�(A
o����R � F � � Phone
Power Suooliec �Y Address •
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Electrical 6oQWcier,/.Coo�aenu-01pep,�e�TI� Contractor LicpoaeA4rahe� Master License Number
1"IVIYI CI.Cti«[IV Vti./FV—VIV1 \M1 WQQJ
Mailing ��'�t_"�� ���'i�i°N�IN 55114
Authorize nature (�ract ompanyor Owner Performing Installation) Phone �, S�� 1
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EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY