P - 78431REQUEST FOR ELECTRICAL INSPECTION
1 - � � � s � � � °w 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��V �, 2.�
❑ NEW ❑ REMODEL ❑ ADDITION EPAIR
GENERAL FE S Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffir Sinnal Rtandarrl 0��.
401 to 800 Ampeie �
Above 800 Ampere �
:UITS / FEEDERS
0 to 200 Amcere � �;
IMMUNICATION, REMOTE CONTROL,
CIRCUITS OF LESS THAN 50 VOLTS
vstem Device or Aooaratus � $.50
I MULTIFAMILY
Su demental Fee � $20
Transfortners u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for S' ns / Outline L' htin �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$8(
Additional Inspection Trips � $20
Investiaative Fee
total fee is
OTHER ADDITIONAL FEES
Li htin Retrofd � $25 Fixture
Center Pivot irri tion Boom �$40
Manufactured Home Park Lots �$25 � hereby cerlilly that I i ed uie elearicel insmllafion descr�ed nerei� on tl�e dates s�ed:
Recreational Vehicle Park Sites �$5 101�"" ""�
Se arate Bondin Ins ection �$20
S ial Ins ection �$30 r Hour ""' "�10N J � ��
S ecial Ins ection �$.31 er Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED fF NOT COMP TED WITHIN 18 MONTHS
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FOR OFFICE USE ONLY ����
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Request Date: Rough-in inspectian Required? ❑ Yes o Inspection Other Than Rough-In: eady Now 0 WiN Call
—�` O� You must call the inspector when ready! Date Ready:
I ceRify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the eleclrical work at
Job Address (Street, Bo or Route NoJ City Trp Code
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Section Township Range Fire No. County
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Power Supplier Address
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Electrical ConVactor / Company Name ConVador License Number Master License Number
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Mailing Address (6entractor, C^�°�°°�• ^• ^�^ ° �'^ ^' �"°"--)
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Authorized Si nature (Contractor, Phone
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EB-00001A-13 7/1/2000 BOARD OF 0.E ICRY COPY INSTRUCTIONS ON BACK OP YELLOYV COPY