P - 79506REQUEST FOR ELECTRICAL INSPECTION
1 � � � � � � �� � e Minnesota Board of Electricity �
� � P 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
t
3e° (651) 642-0800 TTY/MRS 1-500-627-3529
d www.electricity. te. .us
Identify the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR �
GENERAL FEES Ou r Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 40Q Am re �$25 Su piemental Fee �$20
401 to S00 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, 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 Trips Each Dwellin UnR �$80
CIACUITS, CIRCUITS OF LESS THAN 50 VOLTS Addftional Ins ion Tri �$20
Each S stem Device or aratus �$.50 Investl ative Fee
ADDITIONS TO THE GENERAL FEES Reinsoection Fee �$20
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIOI
LigMing Retrofit � $25 per Fixlure
Center Pivot Irriaation Boom � $4(
total fee is
I herebvi cerMv that I insoected the electrical inslallation described herein on tl�e datas sNated:
S arate Bondi Ins 'on � $20
S ecial Ins ion �$30 er Hour Fl"""ru"E`"'°" °"re �7
S cial In ion �$.31 er Mile �� d" G J
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY �
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection O[her Than Rough-I • Re Now � 1MII Call
� v t D� You must call the inspector when ready! Date Ready:
I certity that I am the �ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electricai work at
Job Address (Street, Box, or e No.) � ^ Zip Code
�_ . . t � � . . � _ . // /_ _
Occupam
- Power Supplier
Authorized
EB-00001A-13
Phone
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'/1' �\I As Contractor License Number Master License Number ,,/
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aOrner Perfortning Installation)
�7 �7
�n o Owner rtning Installation) Phone
63 � 7S -S��'
BOARD OF ELECTRICfTV COPY UC710NS ON BACK OF YELIOW COPY