P - 79587REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity —
1� 2� 1� 1 8 6 -p�ss e 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us f �S �"� '�'
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Identify the work covered by this request:
❑ NEW REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
0 ta 400 Ampere �
401 to 800 Ampere
Above 800 Ampere
�UITS / FEEDERS
0 to 200 Amcere �
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Outdoor Li htin Standard (� $1
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transfortners u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns I Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
GNALING Circuits and Two Inspection Trips Each Dwellin Unit �$8f
CIRCUITS OF LESS THAN 50 VOLTS Additionai Insoection Trios �$20
ystem Device or Apparatus � $.50
ADDITIONS TO THE GENERAL FEES
Unit � $25
OTHER ADDITIONAL FEES
Manufactured Home Park Lots �
Recreational Vehicle Park Sites �
Seoarate Bondina Insoection � $;
Fee � $20
TOTAL FEE
(minimum total fee is $20) ���
insoected the electrical installafion described herein on the dates steted:
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FOR OFFICE USE ONLY
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Request Date: � Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now Will Call
� ��O (i You must call the inspeMOr when ready! Date Ready:
I certify mat I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
EB•00001A-13 7/i/2000 BOAHD OF ELECTRICITY COPY � � INSTFiUC710NS ON BACK OF YELLOW COPY