P - 78324REQUEST FOR ELECTRICAL INSPECTION
/� % Minnesota Board of Electricity '—`°
1��`t 1- 3 8 4 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529 =
www. electricity. state. mn. us
❑NEW ❑REMODEL ❑ADDITION ❑REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES �
0 to 400 Am re�$25
401 to 800 Am re�$50
Above 800 Am re � $75
CIRCUITS / FEEDERS
0 ro 200 Am re �$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units C� $50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 er Fxtur
Center Pivot Irri tion Boom �$40
Manufactured Home Park Lots � $25 �
� $30 cer HOUf
Outdoor Li htin Standard �$1 I" �
Traific Si nal Standard � $5
- Su lemental Fee � $20
Trenstortners u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li hfin �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and�or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$S(
AddiNonal Insoection Trios � S20
wn
FOR OFFICE USE ONLY
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� 1 3 4 7 3 8 4 8�
Fee �
TOTAL FEE
total fee is $20) ��•
installation described herein on ihe dates stated:
COMPLETED WITHIN 18 MOI
� ��
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY �WNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) Cily Zp Code
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Section Township � Range Fire Na. County
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Occupan�v C � 1 � � � � e Phon� lo � ^ � � I � � � j C�
Power Supplie� L Address � ' _ / ^' � %
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Electrical Contractor / Company Name Contractor License Number Master License Number
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Mailing Address ontractor, Company or Owner Perfortning Installation)
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A re (Contractor, Company or Owner P rfortning�stallatlon) Phone
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EB-00001A-13 7/1/2000 BOMD OF ELECTIi1CRY COPY INSTRUCTIONS ON BACK OF YELLOW COPY