P - 81776REQUEST FOR ELECTRICAL INSPECTION .
� Q � Minnesota Board of Electricity °` `
!..r � J�- 5 2 9� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us '� '
IdentiTy the work covered by this request: �.r°
❑ NEW ❑ REMODEL ❑ADDITION ❑ REPAIR �
GENERAL FEES Outdoor Li htln Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Su lementai Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
GIRCUITS ( FEEDERS Transformer / Power Su I fa Si ns I Outline Li � �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unft �$80
CIRCUITS, CIRCUVTS OF LESS THAN 50 VOLTS Additional In ction Tri s�$20
Each S stem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinsoection Fee �$20 _
to 12
Lighting Retrofd � $.25 per Fixture
Center Pivot Irrigation Boom � $4(
Manufactured Home Park Lots � $
Recreational Vehicle Park Sdes �
Separate Bonding Inspection � $21
Special Inspection � $30 per Fbur
Soecial I�soection � $.31 oer Mile
total fee is
I insoected tF�e electrical irxtallalion described here� on tl�e dat� stated: I
�2�-�� I
' COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Request te: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: Ready Now �❑ Will Call
'�3 ' � You must call the inspector when readyl Date Ready:
I cer6iy that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
.bb Address (Street, x, or Fioute NoJ s Cily �� Q, , Z1P�? Z
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BOARD OF ELECTAICRY fbPY WBTAUCl10NS ON BACK OF YELLOW COPY