P - 81989REQUEST FOR ELECTRICAL INSPECTION
Q 1 Minnesota Board of Electricity ��
1�.12 3� V H 1 � 1821 University Avenue Suite 5-128, Saint Paut, Minnesota 55104
' (651) 642-0800 TTY/MRS 1-800-6273529 -
www.electricity.state.mn.us �—� '
Iden jfy the work covered by this request: •
❑ NEW O REMODEL ❑ ADDITION ❑ REPAIR �/" � �lG r�l� •
GENEFIAL FEES Outdoor Li htin Standard (� $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re�$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA C� $20
IRCUITS / FEEDERS Trar�sfortner / Power Su i for Si ns i Outline Li htin �$5
0 to 200 Am ere �$5 ONE & 7W0 FAMILY DWELLINGS, EAGH UNIT
Above 200 Am ere �$10 Includes the Service and�or Power Suppiy up to 500 Amperes, All
ALARM, COMMUNICATfON, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin UnR �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins tion Tri s�$20
Each S stem Device or A aratus �$.50 I�vesti ative Fee
ADDITIONS TO THE GENERAL FEES Reins ction Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE �
3 to 12 Units ��50 Per Unit Iminimum total fee is $20
OTHER ADDITIONAL FEES
Li htin Retro�t �$25 r Fixture
Center Pivot Irriaa6on Boom � S40
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I herebvi certifv ihat I inspected the electrical instaHatlon described herein on the dates stated:
FOR OFFICE U8E ONLY
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Re9��Dy�e� Rough-in Inspection Required? ❑ Yes Inspection Other Than Rough-In:
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(�,J You must call the inspector when readyl Date Ready:
I certify that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request i
Jo ddress (Street, Box, oute No
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of the electrical work at:
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Company or Owner Pertortning Installation)
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BOARD Oi EJ.ECTAICITV COPY
Master
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INSTRUCTIONS ON BACK OF YELLOW COPY