P - 79670REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity �"�
1�� 4�� 1 3 g ' 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
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� .: ,� (651) 642-0800 TTY/MRS 1-800-627-3529 � ��
� www. electricity.state. mn. us '' ''
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�NEW�L7REMODEL DA DI ONr ,❑ EPA R��
SERVICES / POWER SUPPLIES Traftic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental 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 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspec6on Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S em Device or A aratus (� $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins 'on Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE .
s to t2 units �$5o Per una (minimum tota! fee is $ (��
EaCh Additionel Unit �$25 roa wsvECron use a�iv
OTHER ADDITIONAL FEES
Li htin Retrofit (� $.25 r Fixture
Center Pivat Irri ation Boom �$40
Manufactured Home Park lots �$25 I hereby certilly that I inspected me electriral installarion desaibed herein on me dates stated:
Recreational Vehicle Park Sites � $5 "a'�"'" °"'�
S rate Bondi In ion �$20
S cial Ins ection �$30 er Hour F'"�"� °"'�
S ial Ins 'on �$.31 r Mile �� rO �G-3
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
�R OFRCE USE ONLY
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Reauest Date: Rouah-in Insoection Reauired? s ��. Insoection Other Than Rouah-In: eadV NOW ❑�11 Call
� � You must call the inspector when ready!�� � � Date Ready: � �
I ceRify that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Ad�� S� , BO�� ut�/�_ „_�� C' ��L / Zi����
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Mailing Address ConV or, Cqm ny or Own rfortning Ins lation)
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EB-OOOOtA-13 7M/2000 � BOARD OF ELECTRICfTY COPY INSTRUCTIONB ON BACIC OF YELLOW COPY