P - 78822REQUEST FOR ELECTRICAL INSPECTION
_ �, , Minnesota Board of Electricity
1� 2 5�7 - 8 5 5 182� University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 -
;......
www. electrici ty. state. mn. us
Identify the work covered by this request:
NEW ❑REMODEL ❑ADDITION ❑REPAIR �1 ��l—��C
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su IemeMal Fee �$20
401 to 800 Am re �$50 Transformers u ro 10 KVA �$70
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transfortner / Power Su for S' ns / Outline ' Min �$5
0 to 200 Am re�$5 ONE & TWO FAMILY DWEILINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Tri Each Dwelli Unil �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additio�al Ins ' n Tri �$20
Each S stem Device or ralus �$.50 +SO
ADDITIONS TO THE GENERAL FEES Rei ion Fee �$20
MULTIFAMILY DWELLINGS PER UNI ���_ �Vh� �„ ���,p�„ TOTAL FEE
3 to 12 Units �$5o Per unit (minimum total fee is $20) �•�
Li htin Retrofit �$25 r Fixture .
CeMer Pivot Irrigation Boom � $40
Manuhactured Home Park Lots �$25 I herebvi cemfv that I irspected aie electricel rc�stalla6on described herein on the deres sreted:
�I t 'on � $30 r Hour V'V °�'"�'
al Inspection � $.31 per Mile
S INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLE
7,
I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work ar
Job Address (SVeet, Box, or Route No.) City Z�p C�
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Section Township Ran�e Fire No. Countv
Occupant
C-�En.1
Power Supplier
Phone
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Elecfiral Contractor / Company Name Contractor License Number Master License Number
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Mailing Address (Contrector, Company or Owner Performing Installation)
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horized Signature ( tractor, Company or Owner PeAorming Installation) Phone
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EB-00001A-73 /1/2000 � BOAHD OF ELECTpICITY COPY INSTRUCTIONS ON BACK ELLOW COPY