P - 79695REQUEST FOR ELECTRICAL INSPECTION
1 �,� � ��� ee �- Minnesota Board of Electricity
� � � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
a� � (651) 642-0800 TTYIMRS 1-500-627-3529 �����j�
www.electricity.state.mn.us " '
Identity the work covered by this request: ,
❑ NEW ❑ REMODEL ADDITION ❑ REPAtR ,�Jl u-�.0 ��l�r�'Q' 'e��U°�'�'�c%/ �
ENERAL FEES Outdoor Li 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 re �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htln �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service andlor Power Suppty up to 5� Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circufts and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20
Each Svstem Device or Aooaratus �$.50 Investiaative Fee
OTHER ADDITIONAL FEES
Retrofit � $25 oer Fixture
Recreational Vehide Pa�C Sites � ""'"y""
Se arate Bondi Ins tion (�
S ial Ins ion �$30 er Hour """LNS°C°"0N
S ecial Ins ection �$.31 er Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED 1F NOT 1
FOR OFFICE USE �Y
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total fee is
herein on Me dales s�eted:
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'ED WITHIN 18 MONTHS
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Request Date: �(� Rough-in Inspection Required? ❑ Yes � No Inspection Other Than Rough-In: (,J Reatly Now � WIn can
�JQ�� V� You must call the inspedor when ready! Date Ready: -�p�
I certiiy that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) Ciry Zip Code
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Section Township Range Fire No. Counry
I Power
Efectrical CoMraclor / Comparry
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Mailing Address (Contrac[or, Co
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EB-00001A-13 7/1/2000
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Phone
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Contractor l�c:ense Number Master License Number
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or Owner Pertorming Installation) � `�
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ny r rtortning Installetio Phone /���
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BOARD OF ELEC7RICRY COPY � R13TRUCTIONS ON BACK OF YELLOW COPY