P - 82022REQUEST FOR ELECTR{CAL INSPECTION
Minnesota Board oi Electricity
��� 2�� 6 0� 1821 Un'sversiry Avenue Suite S-128, Saint Paul, Minnesota 55t04
� r; d� (651) 642-0800 TTY/MRS 1-80Q-627-3529
,� � �� www.electricity.state.mn.us
IdentiTy the work covered by this request:
❑NEW �EMODEL f�ADDITION ❑REPAIR ��, � l`�I I i �11 � CU� il � L � / � / �_11i� _
0 td 400 Am ere �$25
401 to 800 m erp e�$50
Above 800 Am ere � $75
CUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am ere C� $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNt
3 to 12 Units �$5� Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 er Fi�Rure
Centsr Pivot Irri ation Boom �$40
Manufactured Home Park Lots � $25
Recreational Vehicle Park SRes � $5
Se arate Bondi Ins 'on � $20
Soecial Insoection � $30 oer Hour
Su lementai Fee � $20
Transformers u to 1� KVA �$1�
Transformers over 10 KVA � $2�
Transformer / Power Su I for Si ns / Outline Li hGn �$5
ONE & NVO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling UnR �$8(
Additional Ins ection Tri s�$20
Investigative Fee
Reinsoection Fee � $20
tOta1 fee is
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I insoected the electricel inslallaUon
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PLETEO WITHIN 18 MONTHS
iOR �FICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes Irupection Other Than Rough-In: ❑ Reatly Now Will Call
-' �� O You must call the inspector when readyl Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the eiectrical work at
Job Address (St�eet, Box, or Route No.) City „ ,, Zip Code ,
� Occupanf
i3562 t+E
Mailing Addre
Authorized ' ature
EB-OOOOtA-53 7/1/2000
Range Fire No. Counry �
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Phone
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Add ss
p�C'i'.� + • Contractor ti�nse Number Master
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BOARD OF ELECTRICffV COPY INS7flUCTIONS ON BACK OF YELLOW COW