P - 78647REQUEST FOR ELE�TRICAL INSPECTION
1� 3 3 4 0 3 5 Minnesota Board of Electricity
— � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. state. mn. us
Identity the work covered by this request: � a A r�
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❑NEW EMODEL ❑ADDITION ❑REPAIR � ���
GENERAL FEES Outdoor Liahtina Standard �$1
0 to 400 Am ere �$25 B o /
401 to 800 Am re�$50
Above 800 Am re � $75
CIRCUITS / FEEDERS
0 to 200 Am re �$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S em Device or ratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
'� `+�'-e�-- '�:
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. : : : : : : . . . :....: �' :
Su lemental Fee � $20 � — -
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su for Si ns / OuNine Li hU �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuils and Two Inspection Tri Each Dwellin Unit �$8(
Addifional Inscection Trios � $20
Fee �
total fee is
Retrofit � $25 r Fixture -
Pivot Irri Gon Boom � $40
actured Home Park Lots �$25 g hereby cerdfy thet I inspected the electrical " IaEOn d�s�re n on Ihe d�stes�
�tional Vehide Park Sites � $5 A01GN" °AiE
�te 8ondin Ins ection � $20 p� " -3 — �3
d Ins 'on �$30 r Hour F"u` "s�E°"°" ) °"�
d Ins ection �$.31 r MNe � I 2-`� �3
3 INSTALLATION AAAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE OMLY
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Re uest D t: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: �J Ready Now U Will Getl
��^ D� You must call the inspector when ready! Date Ready:
i certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
EB-OOOOtA•13 7H/2000 � BOAAD OF ELECTRICRV COPY INSTRUCTIONS ON BACK OF YELLOW COPY