P - 79009/� REQUEST FOR ELECTRICAL INSPECTION
�— 6�f. �� 6 0� � Minnesota Board of Electricity -
1821 University Avenue Suite 8, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MR l-BO�G 7-3529 www.electricity.state.mn.us
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❑ NEW ❑ REMODEL ITION ❑ REPAIR Desc '�ng the b�pk o copy if necessary - the work covered by this request:
ZiEIVERAL FEES
SERVICE51 POWER SUPPLIES
0 to 400 Am ere $25
401 io 80D Am ere $50
Above 800 Am re $75
CIRCUITS � FEEDERS
/ 0 to 200 Ampere (d $5 ,p ,L
T P,bove 200 Ampere @$10 �
AIARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS TNAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL I
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$5D Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Li htin Retrofit $.25 er Fixture
Center Pivot Irti aation Baom $40
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites $5
Se arate Bondin Ins tion $20
Special Inspection p$30 per Flour
Transformers u to 10 KVA $10
Transformers over 10 KVA �$ 20
T Transformer I Power Suppty for Signs I OuUine LightinQ @$5
ONE & TWO FAMILY DWELLIN�S, EACH UNIT
fncludes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$60
TOTAL FEE � �
(minimum total fee is $20) ���'
THIS MEA FOR INSPFCTOR USE p1V
I he2by cerfiry Mat I inspecled the electrical insfalla6on described f�n on tlie dates sfated:
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Rea � Rough-in Inspection Required? ves ❑ nw o-�speceo� oa,e� Tnan �n�+n: waedy r�+ O ws cai�
��3 �� You must call the inspector when readyl Date Ready. - �
I cer6fy that I am ihe ICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request mspection of Cie electrical wak at:
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. IN87RUC710NS ON BACK OF YELLOMFC� • • BpARp pF ELECTRICITV CAPV
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Please Provide Two (2) Phone Number(s) Induding Area Code
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ise Number Master Electricien or Pvxer Limited T ''an
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� License Number / �
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Phone (s)
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EB•00001A-14 8.1.2002