P - 80493REQUEST FOR ELECTRICAL INSPECTION
1� 16 7 2 9 3 �e a Minnesota Board of Electricity —
� � 1821 University Avenue Suite 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:
❑ NEW ❑ REMODEL ❑ADDITION ❑ REPAIR " `� �
GENERAL FEES Out o Li htin Siandard �$t
SERVICES / POWER SUPPLIES Traific Si nal Standard �$5
0 to 400 Ampere �$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
IRCUITS I FEEDERS Transformer / Power Su for Si ns I Outline li htin �$5
0 to 200 Am re �$5 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, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ction Tri �$20
Each S stem Device or A aratus �$.50 Investi tive Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE T��
3 to 12 Units �$50 Per UnR (minimum total fee is $2 �/
EaCh Additi0�el Uhit �$25 FOIi INSPECTqi USE ONLV
OTHER ADDITIONAL FEES
Li htin Retrofft �$25 er Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots �$25 i hereby certi that I inspected the electr�al installaHon desaibed herein on the dates stated:
Recreational Vehicle Park Site�-� $5 C; / , ���HIN ��
� I Special Inspection �$ 31 per Mile � � ��� �~ `—'` I
THIS INSTALLATION MAY BE ORDERE_D DISCONNECTED IF NOT_COMPLETED WITHIN 18 MONTHS _
FOR OFFICE USE ONLY ��
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Req Da � Rough-in Inspection Required? ❑ Yes No Inspection Other Than RougMln: eady Now ❑ wll Call
You must call the inspector when readyl Date Ready:
I certi(y that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work aF.
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Number � Master License
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EB-00001A-13 7/tY2000 BOARD OF ELECTRIC(TY COPY INSfHUCT10NS ON BACK OF YELLOW COPY