P - 79535REQUEST FOR ELECTRICAL INSPECTION
1�81 2 8 5 P s Minnesota Board of Electricity
- a � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
��e��� (651) 642-0800 TfYIMRS 1-500-627-3529
` www.electricity.state.mn.us
Identity the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard (� $5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere (� $50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer I Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere (� $10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20
Each S stem Device or ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee (� $20
3 to 12 UniLs �$50 Per Unit
Each AddRional Unit � $25
OTHER ADDITIONAL FEES
Center Pivot Irrigatbn Boom � $4(
Manufactured Home Park Lots � $
Rec�eational Vehicle Park Sites �
Separate Bonding Inspection � $2i
Soecial Insoection � $30 oer Hour
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total fee is
installation described herein on the dates
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFlCE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No' Inspection Other Than Rough • Now ❑ Will Cal�
�� � You must call the inspector when readyl Date Ready:
I certiiy that I am tHe;�kIEENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elechical work at:
Job Address (Street, Box, or Route No.) A ZP ��
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EB-00001A-13
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Range Fire No.
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Contractor License Number
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� BOARD OF ELECTRICITY COPY
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INSTRUC710NS ON BACK OF YELLOW COPY