P - 82470REQUEST FOR ELECTRICAL INSPECTION
�� � � � � � � 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
Identify the work covered by this request: 4��� � � f-- 27 qD 1
❑ NEW ❑ REMODEL ❑ADDITION REPAIR � ,2
GENERAL F S Outdoor Li htin Sta ard �$1
SERVICES I POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transtormers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I tor Si ns / 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, Ali
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$8f
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri �$20
Each S stem Device or ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Rein ' Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$50 Per Unit (minimum total fee is $20
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Recreational Vehicle Park Sites �
Seuarate Bondina Insoection � $;
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I here6vi cerMv that I insoected the electricel insfallation
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FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes No Inspection OUrer Than Rough-In: ❑ Ready Now � Wilt Call
Q � � O You must call the inspectar when readyl Date Ready: ! �
I certify that I am the ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of Ure electrical work at
Job Address (Street, Box, or Route No.) C' rp Code
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OccupaM
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EI rical Contractor / Company Name
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Mailing Address (CoMrector, Company
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Authorized Signature (Contractoq Com
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EB-00001A43 7/1/2000
Phone
or Owner PAffortning Installation)
BOMD OF ELECTRICITY COPY
Number
License Number
Phone '
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INS7AUCTIONS ON BACK OF YELLOW COPY