P - 78492REQUEST FOR ELECTRICAL INSPECTION
1�� g 2�'� J C� � Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 lTY/MRS 1-800-6273529 www.electricity.state.mn.us
❑ NEW REMODEL ❑ ADDITION ❑ REPAIR Describe -usin the b�k of the white copy if necessary - the work covered by this request:
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GENERAL FEES Outd r Li htin Standard $1
SERVICES / POWER SUPPLIES Traffic Sianal Standard Cd $5 _ 1_ n/.
401 to 800 Am re $50
Above 800 Am re $75
CIRCUITS ! FEEDERS
0 to 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 ratus $.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units Q$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Lighting Retrofit � $.25 per Fixture
Center Pivot Irrigation Boom $40
M�ufactured Home P�k Lofs � $25
Recreational Vehicle Park Sites � $5
�arate Bondinp Inspection � $20
Speci� InspecGon �1$30 per Hour
Speci� Inspection � $.31 per I�ile
S INSTALLATION MAY BE ORDi
' illl II III II II I II 11111111 il l l( II �I � I� p�l I�I
14929368
Transfortners u to 10 KVA $10 S7"— -
Transformers over 10 KVA (a� $ 20
Transformer I Power SuDp�Y for Siqns / OuUine Liqh6nq $5
ONE 6 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$60
(minimum total fee is $20) � `r(J �
THIS NiEA FOR INSPECTd2 USE ONLY
I hereby certify tlW I inspected the electrical insfall�on described herein on the dafes sia6ed:
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nsconNecTED IF NOT COMPLETED 1MTHIN �
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°a� Roughin Inspectlon Required? dfYes O No Inspection Other Than Rough-In: ❑Ready No�VMII Call
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� ZG Q 3 You must call the i�spector when ready! Date Ready:
I certi(y that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
INSTRUC n7NS ON
BOARD OF ELECTRICITY CAPY
EB-0OOOtM11 8.1. 2002