P - 78313REGlUEST FOR ELECTRICAL INSPECTION
1 3 4 7 4 2 5 Minnesota Board of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
' (651) 642-0800 T'fY/MRS 1-800-627-3529 - _
www.electricity.state.mn.us
Identify the work covered by this request:
❑ NEW �REMODEL ❑ ADDITION ❑ REPAIR
0 to 400 Am ere �$25 1 Ocg —•
401 to 800 Am ere �$50 �� v�
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am re�$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S em Device or aratus �$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Lighting Retrofit � $25 per Fixture
Center Pivot Irrigation Boom � �4(
Manufactured Home Park Lots � 9
Recreational Vehicle Park Sites �
Separate Bonding Inspection � $2i
Soecial Insoection � $30 cer Hour
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Outdoor Li htin Standard � $7
Traific Si nal Standard � $5
Su lemental Fee � $20 '-^ —�-
Transformers u to 10 KVA �$10 %9�� c
Transformers over 10 KVA � $20
-' Transformer / Power Su d for Si ns / Outline Li htin �$5
' ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Ins tion Tri s Each Dwellin Unit �$8(
Additanal I ' Tri � $20
Investi ative Fee
Reinsoection Fce � $20
(minimum total fee is $20) •�u
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I hereby ced' that I inspected the electrical installafion de ri d erem an the ates sta
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THIS INSTALLATION MAY BE URDERED DISCONNECTED IF NOT COMPLETED WITMIN 18 MONTHS
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FOR OFFlCE USE ONLY � ,� '��,3
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Request te: Rough-in Inspection Required? ❑ Yes ❑ No Inspection O[her Than Rough-In: ❑ Ready Now ❑ Will Call
Q You must call the inspector when ready! Date Ready:
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY �QWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, o Rou[e No.) City Zip Code
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Section Tawnship Range Fire No. County
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Power Supplier
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Electrical Contrac[or / Company Name
Mailing Address (Contractor,
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Phone
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Address
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BOARD OF ELECTRICITY COPY
Number
Phone
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INSTHUCTIONS ON BACK OF YELLOW COPY