P - 81570REQUEST FOR ELECTRICAL INSPECTION
° Minnesota Board of Electricity
1����- 511 ��?_ �821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OS00 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us
Identify the work covered by this request: -��� W �`L �C .— �� �L
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❑ NEW ❑ REMODEL p ADDITION REPAIR � � y� ��,
GENERAL FEE Outdoor Liohtina Standard �$1
0 ta 400 Am ere �$25
401 to 800 Am ere �$50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
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
Lighting Retrofit � $25 per Fixture
Center Pivot Irrigation Boom � $4(
Manufactured Home Park Lots
Transformers u to 10 KVA �$10
Transfortners over 10 KVA � $20
�Transformer / Power Supply for Signs / Outline Lighting �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$S(
Additional Insoection Trios � $20
S ecial Ins ion �$30 er Hour `� "'�'`°'"'"'
Special Inspection � $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTE
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes o
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Job Address (Stree.�x, or
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Section Townshio
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lough-In: ❑ Ready Now ❑ WIII Call
You must call the inspector when reatlyl � � Date Ready: �`�� !�s ��(� �
NSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
ute No.) Ciiy Zip Code
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Elec[rical Contrador / Compeny Name
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Mailing Address (Contrador, Company or Owner
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Authorized Signature ontractor
EB-00001A-13 7/i/2000 �
Range
Phone
/./l � 7Y,C--
BOARD OF ELECTRICITY COPY
Number � Master License Number
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INSTRUCTIONS ON BACK OF YELLOW COPY