P - 80503REQUEST FOR ELECTRICAL INSPECTION
�� Minnesota Board of Electricity ""�
��`� � O� 6 2 3 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55t04
�a . (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 (�/ L(�I / lL�— � ' ' [ � � LC- •
GENERAL FEES oor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lementai Fee �$20
401 to S00 Am ere �$50 Transformers u to 10 KVA C� $10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS ' Transformer I 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 re �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Tri s Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S stem Device or aratus �$.50 Investl tive Fce
ADDITIONS TO THE GENERAL FEES Reins ctan Fee �$20
MULTIFAMILY DWELLINGS PER UMI TOTAL FEE
3 to �2 Units �$5o Per unit (minimum total fee is $20)
��..ti eaa�.�....�i i i..�� r� c�c ron insrECron usE w+�v Il4r
Retrofrt � $25 cer Fixture
Manufactured Home Park Lots �$25 �V J i nereby certi that I inspected the electrical installation described herein on the dates stal
Recreational Vehicle Park Sites �$5 HOUGH IN ��
Se arate Bondin Ins ion �$20
S eCi81 InS eCtiOn �$30 f Houf FINAL INSPECTION o�h
S cial Ins ection �$.31 r Mile ��'%'
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18_MONTH:
FOR OFFlCE USE ONLY
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uasf oate� Reuah-in Insoection fleauired? fl Yes Insoection Other Than 6touah-In: i _. dV Now ❑ Will CE
/��, �(/ You must call the inspedor when readyl Date Ready: C/�
i certiiy that I am the�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and her y request inspection of the electrical work at
EB-00001A-73 7/1/2000 BOARD oF ELEC�RIGR� GOP1 INSTNUI:1�lJ� vn DA�:R Vr ieu�n i:imr