P - 79701REGlUEST FOR ELECTRICAL INSPECTION
���� J- 5 9 0 Minnesota Board of Electricity �""�
1821 University Avenue Suite S-128, Saint Paui, Minnesota 55104
m '�' (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us '� '
Identify the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Su iemental Fee �$20
401 to S00 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I tor Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 includes the Service and/or Power Supply up to 500 Amperes, Atl
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Ins ection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20
Each S stem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$50 Per Unit (minimum total fee is $
EaCh Additi0n81 Ut1it � $25 F0p'"��0" `� °NLV
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fixture
Center Pivot Irri tion Boom �$40
Manufaciured Home Park Lots �$25 � hereby certiy mat I in the etectrical insta��ation described herain on the dates s�ed:
Recreatbnal Vehicle Park Sites �$5 '�" "' DA7E
S rate Bondin Ins ion �$20
S ial In ion (� $30 er Hour `�'11NSPC"�"' - �DA7ErZ
S ial In ion �$.31 r Mile Z^ �— `� �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED If NOT COIIAPLETED WITHIN 18 MONTHS
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Request Date: Rough-in Inspeclion Required? ❑ Yes ❑ No Inspection Other Than Rough-In: Ready Now ❑ WiN Call
You must call the inspector when ready! Date Ready: �
I ce�ify that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe electrical work at:
Job Address ( t t, Box, or RQy[e No. Cily Z�P �
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Occupant
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Electrical ConVa r/ Company Name
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Authorized Signature (Contract aQY or
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Phone
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Addres
CoMractor Licenae Number
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Number
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BOARD OF ELEC7RICITY COPY INSTRUCTIONB ON BACK OF YELLOW COPY