P - 82411REQUEST FOR ELECTRICAL INSPECTION �
1• V'� �-F 15 9 � m Minnesota Board of Electricity
� � � a 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us " '
identify the work covered by this request:
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❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard �$1 -
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
to e��2fa—� D Su lemental Fee �$20
401 o S00 Amcere �$50 Transformers uo to 10 KVA (� $10
Above 800 Am ere
CIRCUITS / FEEDERS
;UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus �$.50
3 to 12 Units (� $50 Per Unit
Each Additional Unit � $25
OTHER ADDITIOP
Liahtlna Retrofit � $.25 oer Fixture
� Transformer / Power Suppry for Signs / Outline Lighting �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$BL
Additional Ins ection Tri s�$20
Investi ative Fee
Reinsoection Fee � $20
total fee is
Manufactured Home Park Lots �$25 I hereb ce�i that I inspected the electrical installation described herein c
Recrealional Vehicle Park Sites � ��M IN
Se arate Bondin Ins �on � $2
S ecial Ins ection �$30 er Hour `N""ws`E°"°"
S ecial In ection �$.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18
FOR OFRCE USE ONLY
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Than Rough-In: �Ready Now
� R"� r�'0� I You must call the inspector when readyl I Date Ready: I
I certi(y that I am the �.LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at