P - 79933� REGlUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1-396-177 � 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:
Q@EW ❑ REMODEL ❑ ADDITION ❑ REPAIR
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS (PER UNI
3 to 12 Units �$50 Per Unit
Each Addi6onal Unit � $25
Retrofit � $25 per Fxture
'ivot Irriqation Boom � $4C
� $30 DBf F�OUI
XGEL ENEROY SAVER'S SWITCH
to 1
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Additional Inspection Trips � $20
Investigative Fee
Reinspection Fee � $20
TOTAL FEE
(minimum total fee is $20)
FOR INSPECTOfl USE ONLY
I hereby Cer6ty Mat
RWGH IN
FINAL IN3PECTION
DATE
OATE
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� FOR OFFICE USE ONLY
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Reque Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-in: Ready Now ❑�II Call
You must call the inspector when ready! Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Jab Address (�, Bo .��te Ww� � N� c��y ��Y zP coaa ���
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Section Township Range Fire Na. Caunty .
occuWlat��� �VENA� �U � �� Phone
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Electric$I �,qp�� /,J i��y.[J��Q� Contractor Licgc;erlyrIll�� Master License Number
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AutFrorize nature (�trador� ny or Owner Performing Installation) Phone
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EB-00001A-13 7/1/2000 BOARD OF ELECTRICIN COPY INSTRUCTIONS ON BACK OF YELLOW COPY