P - 77300REQUEST FOR ELECTRICAL INSPECTION
1 3 4 7 4 9 4 Minnesota Board,of Electriciry
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
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www. electriciry. state. mn. us
Itlenlity the work coveretl by this request:
❑ NEW � REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 l0 400 Am ere �$25
401 to 800 A re�$50
Above 800 Am re � $75
C RCUITS / FEEDERS
0 to 200 Am re �$5
Above 200 Amcere � $10
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots � �25
� - �-e �ri ��-e �
Outdoor U htl Standard � $1
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
� Circuits and Two Ins ion Tri s Each Dwellin Unit �$8(
Addi�onal In ion Tri s�$20
InvestiQative Fee
w�n� roc
total fee is $20) ���
Fan
I herebvi certiNN that I insuected the electrical installaAon described he2in on the dates
Se arete Bondin Ins ection �$20
S ial In 'on �$30 r Hour F'""` "�Q"0N �"T�
S ial In 'on �$.31 r Mile
/� �'
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN #� MONTHS
FOR OFFICE USE ONLY ��`
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Request Date: Rough-in Inspedion Required? Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
V �� � 5 You must call the inspector when ready! Date Ready:
I certi(y that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY � OWNER and hereby request inspection of the electrical work at:
EB-00001A-13 7/1/2000 BOAflD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY