P - 77153REQUEST FOR ELECTRICAL INSPECTION
1��'-t C- 513 8'21 Un'oivers � A enue S tte'S 28, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electriciry.state.mn.us � dQ�' b��C��
Identi(y the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION REPAIR
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traific Si nal Standard �$5
0 to 400 Am re �$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
CIRCUITS / FEEDERS Transformer / Power Su for S' ns / Outline ' hti �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT ,
Above 200 Am re �$10 Includes the Service and/or Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Ins ction Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S stem Device or ratus �$.50 Investi tive Fee
ADDITIONS TO THE GENERAL FEES Reins ' n Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$50 Per Unft (minimum total fee is $20)
Each Additional Unit � $25 f°" "'�"`�`0R "� °NLV `
OTHER ADDITIONAL FEES
Li htin Retro�t �$25 r Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots �$25 I hereb cemty mat I inspected che electrical instsllatlon described herein on n�e dates stated:
Recreational Vehide Park Sites � $5 "01GHN °"'�
rate Bondi Ins 'on � $20
Soecial Insoection � $30 cer Hour �`"'°" /'i °";, ,_
FOR OFFICE USE ONLY �� �.� K
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Request Da/fe: Rough-in Inspectbn Required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now � Will Call
8J {�+ /� 5 You must call the inspector when ready! Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electriral work at:
Job Address (Street, Box, or Route No.) City Zip Code
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Section Township ang Fire No. Counly
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Occupant Phone
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Power Supplier Address
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Electrical Contractor / Company Name Contractor License Number Master License Number
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Mailing Address (Contrador, Company or Owner Performing Installation)
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Authorized Signature ntr or, Comp y or Owner Perfortning Installation) Phone
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EB-0OOOtA-13 7 2000 BOARD OF ELECTRICIIY COPY INSTpUCT10NS ON BACK OF YELLOW COPY