P - 78321REGIUEST FOR ELECTRICAL INSPECTION
/� % Minnesota Board of Electricity �
���`t 1- 3 9 0 �82� University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electriciry. state. mn. us
Identify the work covered by this request:
❑NEW (gREMODEL ❑ADDITION ❑REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am re �$25
401 to 800 Am re�$50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am ere �$5— —
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem �evice 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 htl Retrofil �$25 r Fixture
Center Pivot Irri tion Boom �$40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites � $5
Se rate Bondi Ins ion �$20
ial I � $30 r Hour
S ecial Ins ection �$.37 r Mile
THIS INSTALLATION MAY BE ORDERE
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Traffic Si nal Standard �$5 I
Su lemental Fee � $20
Transfortners u to 10 KVA �$10
Transfortners over 10 KVA � $20
Transformer I Power Su for Si ns / Outline Li hGn �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and�or Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$8C
Additional Inspection Trips � $20
Investiaaiive Fee
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total fee is $20) / S�
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I herebvi certifv that I insoected the electrical installabon described
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D DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY , i���, (
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Reque Date: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now Will Call
� fQ � You must call the inspector when ready! Date Ready:
I certiiy that I 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� � Ran� Fire No. Counly� ��
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Occu nt Phone
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Power Supplier Addres �
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Electrical Contractor / Company Name Contractor License Number Master License Number
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Mailing Address (Contractor, Company or Owner Performing Installation)
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Authoriz Signature (Contractor, Company�r Ow r erforming Installation) Phone
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EB-00001A- 7/1/2 BOARD OF ELECTRICRY COPY INSTRUCTIONS ON BACK OF YELLOW COPV