P - 78456REQUEST FOR ELECTRICAL INSPECTION
`1 � 1� 9 5 6 � Minnesota Board of Electriciry
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. state. mn. us
request:
❑ NEW ❑ REMODEL �AQ[
GENE
SERVICES / POWER SUPPLIES
0 to 400 Am re �$25
407 to 800 Am re(� $50
Above 800 Am re � $75
CIRCUITS / FEEDERS
0 to 200 Am re �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, RE�
CIRCUITS, CIRCUITS OF LESS
Each Svstem Device or Aoa
V ❑ REPAIR Di �/" 1
fEES Outdoor Li htin Standard �$1
Traffic Si nal Standarcl � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer I Power Su I for S' ns / OuUine Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Senrice andlor Power Supply up to 500 Amperes, All
CONTROL, SIGNALING Circuits and Two Inspecdon Trips Each DweNin Unit �$8(
� 50 VOITS Additional Ins 'on Tri �$20
� $.50 InvesUgatNe Fee _
Each Additional Unit � $25
OTHER ADDITIONAI FEES
Lighting Retrofit � $25 per Fixture
Center Pivot Irrigation Boom � $40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites �$5 _ J
Seoarate Bondina Insoection � $20
�
total fee is
that I inspecled the electrical installation des�xibed herein on tlie
� eaai m� vwuon rr yav i noui L`� Q� I
Special Inspection (� $ 31 per Mile
� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MO HS
�---. - _ _ _ _ _ _ _ __
_
_ __ _ —
(p`✓S � —�7� ' �8� r.on o�ce usE o�ur _ '�" (n ✓re Se d�Su-Z./ �tJl/\�
� ��I�II ����� ��11� ����1 ���II 1�t'� ��I�� 111�� �I�I (i�l � �' ��� ��
�E 1 3 1 B 9 5 6��E ��o
Request Date: Rough-in Inspeclion Required? ❑ Yes ❑ No InspecGon Other Than Rough-In: ❑ Ready Now ❑�II Call
You must call the inspecta when ready! Date Ready:
1 cerdfy that I am the [�610ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspec8on of ihe elecVical work at
� tW1lN1UlA-1"J //1/LUW � IfVAlIY VF CI.Cli1X1411 i l4UYi �na�nw�Nna ain ow�.n vr ic��v� wr•