P - 77549� REQUEST FOR ELECTRICAL INSPECTION �
1 3 4 7 4 8 8 Minnesota Board of Electricity
� � 1821 University Avenue Suite S-128, Sai�t Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 - _
www. electrici ty. state. mn. us
Identity the work covered by this request:
❑ NEW EMODEL p ADDITION ❑ REPAIR � wt � WG�-T' `��� J'�t
GENERAL FEES Outdoor ' Min Standard �$1
SERVICES / POWER SUPPLIES Traific S' nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am re�$50 Transformers u to 10 KVA (� $10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transfortner / Power Su for S� ns / Outline Li Min �$5
0 to 200 Am re �$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re�$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit �$SO
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S stem Device or ratus �$.50 Investl tive Fee
ADDITIONS TO THE �ENERAL FEES Rein 'on Fee �$20 �" / a"'
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE �
3 to 12 Unfts �$5o Per Unit (minimum total fee is $20) �
Each Additional Unit �$25 Fon i�,srECron use a+�v
OTHER ADDITIONAL FEES
Li hUn Retrofit �$25 r Fixture
Center Pivot Irri tion Boom �$40
Manufactured Home Park Lots �$25 � hereb ce that I in me electrical insta�lauon described herein an the dat�s sruted:
Recreational Vehicle Park Sites �$5 N01�"" . �+T�
Se arate Bondin Ins ecGon �$20 '��Z,,D —a'J
S 'al Ins 'on � $30 r Hour �'"�CTON �CT�
S ial In ' n�$.31 r Mile —�� �� �`� J
THIS INSTALLATION MAY BE ORDERED DISCONNECTED i NOT COMPLETED WITHIN.38'AIONTHS
FOR OFFICE USE ONLY �„� �� L�
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34 1 3�l 7 4 8 8 7�E
Request Date: Rough-in Inspection Required? es ❑ No Inspection Other Than Rou h-In:
g ❑ Ready Now tll Call
���� Q You must call fhe inspector when ready! Date Ready:
I certity that I am the [8'�ENSED COMRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: