P - 78205REQUEST FOR ELECTRICAL INSPECTION
1� 5� 7- 0 4 4� Minnesota Board of Electriaiy
� 1821 University Avenue Suite S-128, Sairrt Paul, Minnesota 55104
'�` 53�{ S (651) 642-0800 TlY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW MODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
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GENERALFEES
SERVICES / POWER SUPPLIES
0 to 400 Am re 325
401 to 800 Am re S50
Above 800 Am re E75
CIRCUITS I FEEDERS
0 to 200 Am re SS
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or atus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units �$50 Per Unit
Each Additionai Unit @ $25
OTHER ADDITIONAL FEES
Li htin Retrofit $.25 r Fixture
Center Pivot Irti ation Boom $40
Manufactured Home Park Lots $25
Recreationai Vehicle Park Sites $5
Se arate Bondin Ins fion $20
Special Inspection Q$30 cer Hour
Outdoor Lighting Standard
Trafic Siqn� Standard CaD'
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes fhe Service andlor Power Suppiy up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTAL FEE I �
(minimum total fee is $20) �
iM15 AREA FOR INSPECTOR USE MY
I hereby cerCty that I inspec0ed the electrit� install�on described herein on the dates stated:
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Kequasi ua[e: Rough-in Inspection Required? ❑ Yes Insp�tion Other Than Rough-In: ❑Ready N VYII Cali
���� You must call the inspector when ready! Date Ready -
I ceitify that I am the �ICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the electrical work at: