P - 79555REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity �--'��
1����- 5 3 6 °�P � �821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�� �* , ° (651) 842-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us
Identify the work covered by this request: `- �
❑ NEW ❑ REMODEL ❑ ADDITION R �
GENERAL FEES Outdoor Liah6na Standard �$1
� 401 to 800 Am ere �$50 '
Above 800 Am ere � $75
CIRCUITS ! FEEDERS
0 to 200 Am re �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Apparatus �$.50
OTHER ADDITIONAL FEES
� Retrofit � $25 per Fixture
Pivot Irriaation Boom � S40
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Supply for Signs I Outline Lighting �$5
ONE & TWO FAMILY OWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Un8 �$80
Additional Inspection Trips � $20
Investiqative Fee
total fee is
electrical insMallatbn desrxibed herein on tl�e dates stated:
Se rate Bondin Ins ion �$20 ' •
S ecial fn 'on f� $30 r Hour `""`"'S"�"�' e� �7 DA7E
S ecial Ins 'on �$.31 r Mile J K!�"�Z''
THIS INSTALLATION MAY BE ORDERED DISCONNECTED tF COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Request Dat � Rough-in Inspection Required? � ❑ Yes o InspecUon Other Than Rough- . dy Now ❑�11 CaN
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� You must call the inspec[or when ready! Date Rea . �
I certify that I am th NSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job A� ss (St� x, or `o= o.) ����� C�� // � Zi����
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55126�7014
BOARD OF
Phone
Phone RH6NE: (651) 490-13?? I
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