P - 77559REQUEST FOR ELECTRICAL INSPECTION
1 3 4 7 4 8 6 Minnesota Board of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 �+�'1 - _
www. electricity.state.mn. us �C�
Identity the work covered by this request:
❑NEW ❑REMODEL ❑ADDITION PAIR/k�lX"_ �� �..` � �� �'
GENERAL FEES Outdoor Li tin Standard �$1
SERVICES / POWER SUPPLIES Traific Si nal Standard � S5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am e�$75 Transformers over 10 KVA �$20
C RCUITS / FEEDERS Transformer / Power Su I for Si ns I Outline Li htin �$5
0 to 200 Am re �$5 O ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re�$10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMIAUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional I ion Tri s�$20
Each em Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FE
3 to 12 Units �$5o Per Unit (minimum total fee is $20) O�}j
Each Addition3l Unit � $25 `°�' "+s'E°r°A'� °"�Y
OTHER ADDITIONAL FEES �/`y? �y �� j � �
Li htin Retrofi[ �$25 er Fixture ��t S�G7"�`/ r �•�
Center PNot Irri tion Boom �$40 �- ��'
M2flufactUf6d HOrt16 Pa�lc LotS �$25 I hereb certi that I ins ed the electrical inslallation described herein on the d�a es sfateZl'.'
Recreational Vehicle Park Sites �$5 ROUGM IN on�
S rate Bondin In ion �$20 �`��� t�7, ' c�
S ial In Ction �$30 r Hour F1'u""5`EC"°" °"�
S 'al In � � $.31 r Mile � �s �s
THIS INSTALLATION MAY BE ORDERED DISCONNECTE NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Request D te: Rough-in Inspection Required? es ❑ No Inspection Other Than Rough-In: ❑ Ready Now dl Call
J Q � You must call the inspector when readyl Date Ready:
I certi that am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
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Section Township Range Fire No. County�
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Occupant Phone
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Powe� Suoolier Address
Electrical Contractor / Company Name Contractor License Number Master License Number
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Mailing Address (Contrador, Company or Owner Perfortning InsTallation)
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Authorized Sign re(Co or, Company or Owner Pertortn g Installation) Phone
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EB-OOOOtA•13 7/1/2 BOARD OF ELECTRICRY COPY INSTAUCTIONS ON BACK OF YELLOW COPY