P - 79534REQUEST FOR ELECTRICAL INSPECTION
) � Minnesota Board of Electricity ��
�L � 5� O 1 1 �° 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 3
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� ;� (651) 642-0800 TTY/MRS 1-800-6273529 �
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www. e lectrccc ry. sfate. mn. us
Identify the work cavered by this requesT.
❑NEW ❑REMODEL ❑ADDITION C]REPAIR , �
GENERAL FEES Outdoor Li htin 8tandard �$1
SERVICES I POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Ampere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
G4RCUITS / FEEDEflS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Inciudes the Service andlor 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 Additionai Ins ction Tri s�$20
Each S em Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE� �
3 to 12 Units �$50 Per Unit (minimum rotal fee is $20) 1 -
EeCh Additi0n81 Unit �$25 WR INSPECT01i USE ONLY
OTHER ADDITIONAL FEES �i6'S— 1 °' `'�' `�
Li htin Retrofit �$25 r Fixture
Center PNot Irti ation 800m �$40
Manutactured Home Park Lots �$25 I hereb certity that I inspected me elearical installation described herein an the dates stated:
Recreational Vehicle Park Sites �$5 - f01GH1N ��
Se arate Bondin In ion �$20 `
S ecial Ins ection f� $30 er Hour "1°�'"S"�"0N ���.,f
S ial Ins ection �$.31 er Mile s�� ���` Z� V �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
fOR OFFICE USE ONLY
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Request Date: � Rough-in Inspection Required? ❑ Yes �> No Inspection O[her Than Rough-In: '� Ready Now ❑�II Call
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You must call the inspector when ready! Date Ready:
I cerbiy ihat i am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical wark ai:
Job Address (S et, Box, or R te No.) City Zip Code
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Section Township Range Fire No. County !�����
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Occupant Phone
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Power Supplier Address
Electrical Contractor / Company Name Contractor License Number � Master L(cense Number
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Mailing Address (Contractor Company or Owner Perfortning Installadon) � � /�
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Authoriz�d Signature (Contrador, Co or Owner Performing Installation) Phone
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EB-00001A-13 7/1l2000 ( p -�"'� BOARD�OF ELECTRICITY COPY . INS7AUCTION3 ON BACK OF YELLOW COPY�
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