P - 786531-3�2-304 �tl
Identify the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITI E
GENERAL FEES
0 to 400 Am ere �$25
401 to 800 Am ere �$50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REM07E CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A ratus �$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li hrin Retrofit � $25 r
Center Pivot Irri ation Boom
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites � $5
S rate Bondin Ins 'on � $20
S ial In 'on �$30 r Hour
Soecial Insoection � 5.31 cer Mile
REQUEST FOR ELECTRICAL INSPECTION
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
Outdoor Li htinq Standard � $1
TraHic Si nal Standard � $5
Su � demeMal Fce � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transfortner / Power Su for Si ns / Outline Li hd �$5
DNE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, Ali
Circuits and Two Ins ecGon Trips Each Dwellin Unft �$8a
Additional Ins ection Tri s�$20
Invesli aWe Fee
Reinsoection Fee � $20
FOR OFFICE USE ONLY
I 111111111i1 lilil III{I IIIII IIII1 illil 11111 IIII IIII
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total fee is
electrical installalan de�n'bed herein an the
- - � `�
PLETED WITHIN 18 MONTF
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5�
� O You must call the inspectw when ready! ' � Date Ready: � �
I ce�ify at I m the�CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Address (Street, Box, or Route No.) C Zip Code
1 �/G J�' �� � n ��
Section Township Range Fire No. County
3�
Occupant PFrone
�� / D L,�,Y �i��� �'� 3 •- �%� -2�.3/
El��or / Company Name
Mailing ddress (Contractor, Company or Owner erti
Aut n (Contractor, Comp y or Owner
�
EB-00001A-13 7/iM2000
Contractor License Number Master License Number
7
G�.J 1.1�P11., /�tis� �
� Phone
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ELECTRICITY COPY � INSTNUCTONS ON BACK OF YE OW COPY