P - 79931� REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1-396-179 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electriCity.state.mn. us
Identiy the work covered by this request:
❑`NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
0 to 200 Am ere �$5
Ahove 20� Am are � $t0
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or A aratus �$.50
ADDITIONS TO THE GENERAL
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $Z5
OTHER ADDITIONAI FEES
Li htin Retrofit �$25 per FiMure
Center Pivot Irri tion Boom �$40
Manufadured Home Park Lots � $25
Recreatio�al VehisAe Park Sites � $5
Se arate Bondin Ins ection �$20
Soecial Insoection � $30 oer Hour
X�EL ENEROY SAVER'S SWiT�H
Transfortners u to 10 KVA �$10
Transformers over 10 KVA � $20
Transfortners ! Power Supply for Signs ! OuUine UghGng �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Additional Inspection Trips � $20
Investi ative Fee
Reinspection Fee � $20
TOTAL FEE
(minimum total fee is $20)
FOp INSPECTOP USE ONLY
I hereby certity ihat I inspecletl Me electncal installetion described herein on Me detes �
ROUGHIN DATE
FIW1L INSPEC710N /l DATE
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FOR OFFICE USE ONLY
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Reque���2 Rough-in Inspection Required? ❑ Yes (RNo Inspection Other Than Rough-in: � Ready Now ❑ Will Call
You must call the inspector when ready! Date Ready:
I certity that I am the � LICENSED CONTRACTOR ❑ COMPANY � OWNER and hereby request inspection of the electrical work at:
EB-00001A-13 7/1/2000 BOARD OF ELECTRICIN COPY INSTRUCTIONS ON BACK OF YELLOW COPY