P - 75973/� REQUEST FOR ELECTRICAL INSPECTION
1� 9 5���u, 9� � Minnesota Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minn�ota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.elecrizcity.state.mn.us
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_ GENERAL FEES Outdoor Liphtin� Standard CrD. $7
0 to 400 Ampere � $25
401 to 800 AmPere @ $50
Above 800 Ampere (d� $75
,URS/FEEDERS
0 to 200 AmPere G$5
Above 200 Amf�re @$70
tM, COMMUNICATION, REMOTE CANTROL
UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.5p
ADDITIONS TO THE GENERAL I
�IFAMILY DWELLINGS (PER UNllj
3 to 12 UNts @$50 Per Unit
Each Addfional Unit @ $25
orH�aoomow� �es
LighGn Retrofit @ $25 {�r Fl�dure
Center Pivot Irtiaation Boom [a� $40
�lal I�pectlon @ $.31 per Mile �
INSTALLATION MAY BE ORDERED
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19584986
20
ONE & TWO FAMILY DWEWNGS, EACH UNIT
Includ�s the Service and/or Power Supply up to 500 Amperes, All
CUcuits and Two Inspectlon Trips Each DwelUng Unit @$80
TOTAL
(minimum total fee is ;
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I hereby certlfy that I tr��ded tl�e el�tritzl I
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Irerein on tl�e detes smmd: I
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FOR 0�!=1GE USE ONkY
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�1 Rough-in Inspection Requiredl ❑Y� � No I Inapectlon Ofher Than Rough-In: dy Now �WIO Cail I
D� e�� 0 1� You muat call tlre i�pector when readyl DaOe Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspe.�tion of the electrical work at
Job Si�s Street Add�ass
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�'��Pe^t , /- Please Prwida Two (2) Phorte Numbe�s Induding Area Code
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o (Contractor r Per(orming In on) Please Provide Two (2) Pho�re Num��s Induding Area C�e
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! O S N � BOARp OF ELECTRICITV COPY EB-00001A-15 a 1 9nne