P - 79892REQUEST FOR ELECTRICAL INSPECTION
1 ��� ��� A Minnesota Board of Electricity
� � ��e 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 6y this request: ��RV � Gl:
PG+R.i� D �
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard (� $t
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere (� $25 O Su lemental Fee �$20
401 to 800 Am ere (� $50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUI7S / FEEDERS Transformer / Power Su for Si ns I Outline Li htin �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circufts and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S em Device or ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PEA UNI TOTAL FEE
3 to 12 Units �$50 Per Unit (minimum total fee is $20) d5�
EaCh Additi0n21 UnB �$25 r«+ i srECTOa use an�v
OTHER ADDITIONAL FEES �y ���' �-� 2 9 6 2 3
Li htin Retrofit �$25 r Flxture
Center Pivot Irti ation Boom �$40
Manufactured Home Park Lots �$25 I hereby ce ' tliat I inspected tlie electrical inslatlati�on described herein on 1he dates stated:
Recreational Vehide Park Sites �$5 fl01G1'" DA7E
Se rate Bondin Ins ion �$20
S ecial Ins ection �$30 r Hour �1N5°�10N DA1E
S ial Ins ecHon �$.31 r Mile �� Z�j'—�3
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Request Da : qough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now �II Call
!/ � You must call the inspector when readyl Dafe Ready:
I certi(y that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspectiai of the electricxl work at: