P - 78741REQUEST FOR ELECTRICAL INSPECTION
1 ��� O�� e 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: �� s'LC�y ��
❑NEW REMODEL ❑ADDITION ❑REPAIR �UIC'N�L�E I�� �r/� S
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 � Su lemental fee �$20
401 to 800 Am re �$50 • Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
`' 0 to 200 Am re �$5 .�v ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Ir�spection Trips Each Dwelli Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional In ion Tri s�$20
Each Svstem Device or Ao�aratus �$.50 Invesdqative Fee ..G�
3 to 12 UniGs �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Lighting Retrofd � $25 per Fature
CeMer PNot Irriga6on Boom � $40
Manufactured Hortre Park Lots � $25_ (]
Recreational Vehide Park Sites � $5 �
i Fee � $20 • o
TOTAL FEE J!d
(minimum total fee is $20) �• �
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I insoected the electr�al ir�talla6on �saibed herein on the dates stated:
s iai i on � 3;�u r hour .�.__.._.. ,� � 3� .� G3 �
Special Inspection �$ 31 per Mile (
THIS INSTALLATION MAY BE ORDERED DISCONNECTED I OT CONfPLETED WITH N 18 MONTHS
! FOR OFFICE USE ONLY
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Request D te: Rough-in Inspection Required? ❑ Yes o Inspection Otlier Than Rough-In: eady Now Will CaN
3�c� �� You must call the inspector when ready! Date Ready:
I certiiv that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of tlie elecVical work at
EB-00001A-13 �/1/2000 evwnu vr eaca. � m... �. w� . ""