P - 79696REQUEST FOR ELECTRICAL INSPECTION ��- _
� � � � � � � Minnesota Board of Electricity
1 s � � �n' 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
��` �°�' w� (651) 642-0800 TTY/MRS 1-800-627-3529
tivww. electricity. state. mn. us
Identity the work covered by this request: ,
❑ NEW ❑ REMODEL ADDITION ❑ REPAIR ,� s��i(,V � L/� ' I'
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES ( POWER SUPPLIES Traffic Si nal Standard '� $5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUlTS / FEEDERS Transformer / Power Su I for Si ns I Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$70 Includes the Service and�or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Ins ion Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S tem Device or A aratus �$.50 Investi tive Fee
ADDITIONS TO THE �ENERAL FEES Reins ion Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE �
3 to 12 Units �$50 Per Unit (minimum total fee is $20) Q`�
E2Ch Add'Iti0n11 UnA � $25 � ��PE�R � ��
OTHER ADDITIONAt FEES
Liahtino Retrofd � $25 cer Flxture
Recrea6onal Vehicle Park Sites �
on�$.
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�/ —l.C/) You must call the inspector when ready! Date Ready: �( /
! certity that 1 am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Address (Street, Box, or Route No.) Ciqr Zip Code
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� Electrfcal Conhador / Company
(CoMractor, �
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Phone
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Address
CoMractor License Number Master
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EB-00001 A-73 7/1f2000 BOARD OF ELECTRICRY COPY INSTFIUC710NS ON 9ACK OF YELLOW COPY