P - 82436RE` EST FOR E�EC7R��AL INSPECTION
' � � Minnesota Board oi ��Elect�c�y
,� ��� 8�� 3� �� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www.eJ,� iciry.stste.mn.us
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Identify the work cavered by this request: � r�r� G�� /� /� ����r1i � `
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❑ NEW ❑ REMODEL . DDITION REPAIR
GENERAL F S Ouldoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Tra ' Si nai Standard �$5
0 to 400 Am re �$25 S lemental Fee �$20
401 to 800 Am ere �$50 Tra�formers u to 10 KVA �$10
Above 800 Am ere �$75 Tr sformers over 10 KVA �$20
CIRCUITS / FEEDERS Transtormer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE 8� TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service andlor Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$BO
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20
Each S stem Device or A ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to t2 Units �$5o Per Unit (minimum total fee is $20)
Each Additional Unit �$25 FOP INSPECTON USE ONLY
OTHER ADDITIONAL FEES
Li hdn Retrofit �$.25 er Fixture
Center Pivot Irri ation Boom �$40
ManufaCtured Home Park Lots �$25 I hereby certi(y that I inspected fhe electrical installation described herein on the dates stated:
Recreatlonal Vehicle Park Sites � $5 "01GN1N �"�
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Special Inspection �$ 31 per Mile
THIS INSTALLATION�I AAY BE ORDE��D DI�C•ONI�C��IF NQ COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY (� m
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Request Date: Rough-in Inspectlon Required? ❑ Yes ❑ No InspecUOn Olt�er Than Rough-In: eady Naw ❑ Will Call
q' p����0 You must call the inspector when readyl Date Ready:
I certity that I am the �ICENSED CANTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Address (Street, or Rarte No.) City Zip Code
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Sectfon Township Range Fire No. Co �
OccupaM
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Power Supplier � � � ddress
Electrical Contredor / Co p (),, � � �
DEPENDABL� �L�RIC. IN �
Mai e( racto , p�n�or�O�nar Performing Installatii
Coon �api s. �•� �
Authorized Signature (Contract pany or Owner Performi g st
EB-p0001A-13 7/1/'1000 BOARD
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Phone
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ise Number
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ON BACK OF YELLOW COPY