P - 81590REQUEST FOR ELECTRICAL INSPECTION
� Minnesota Board of Electricity
�" � O���� 2 8 ��v 1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104
s (651) 642-0800 TTY/MRS 1-800-627-3529
www. electrici ty. state. mn. us
Identify the work coveretl by this request:
p NEW ❑ REMODEL ❑ ADDITION
GENERAL F
0 to 400 Am re �
401 to S00 Am ere
Above S00 Ampere
CIRCUITS / FEEDERS
0 to 200 Amoere �
CIRCUITS OF LESS THAN 50 VOLTS
vstem Device or Ao�aratus � $.50
Outdoor Lighting Standard � ;
Traffic Signal Standard � $5
Supplemental Fee (� $20
Transformers up to 10 KVA �
Transformers over 10 KVA �
� Transfortner / Power Suppiy for Signs / Outline Lighting �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, AN
Circuits and Two Ins ection Trips Each Dwellin Unit �$BO
Additional Ins ection Tri s�$20
Investi a8ve Fee
Reinsoection Fee � $20
3 to t2 Units �$60 Per Unit (minimum total fee is $20) U'—
Each Additional Unit �$25 PoR �bSPECTOR USE OIAY
OTHER ADDITIONAL FEES
L� htin Retrofit �$.25 r Fixture
Center Pivot I' ation Boom �$40
Manutactured Home Park Lots �$25 I hereb certity that � ins ed me electrical insta�lanon desaibed herein on tl�e dates stated:
Recreafional Vehicie Park Sites �$5 �.� `�" �' DA7E
S rate Bondin In ion �$20
S ial Ins 'on �$30 r Hour Fl""""S"ECr'°" °",�
S ial Ins 'on � $.31 r Mile '� � "�'""l� —�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTFIS
FOR OFFICE USE ONLY
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Request Date: Rough-in InspecGon Required? ❑ Yes ❑ No Inspeclion Other Than Rough-In: Ready Now ❑ Will Call
' — —� You must call the inspectw when readyl Date Ready:
I certiiy that I am the �,LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: