P - 81791REQUEST FOR ELECTRICAL INSPECTION
� � � � � � � p � � Minnesota Board of Electricity
L} 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� a� (651) 642-0800 TTY/MRS 1-800-627-3529
� ! www.electricity.state.mn.us '� � �
Identify the work covered by this request:
❑NEW ❑REMODEL DADDITION ❑AEPAIR �
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to B00 Am ere �$50 Transtormers u to 10 KVA �$10
Above 800 Ampere �$75 Transtormers over 10 KVA �$20
0 to 200 Ampere � $5
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTROL, SIGI
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service ancUor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelli Unit �$8C
Additional Inspection Trips � $20
Investiaafive Fee
3 to 12 Units �$50 Per Unit (minimum total fee is $
Each Add'Rional Unit �$25 F0R1N�1°"'�E 0NL1
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 er FuRure
Center Pivot Irri a6on Boom �$40
ManufBCtured Home Park Lots �$25 I hereby cerMy that I ins ed the electrical installa6on described herein on the dates afated:
Recreationat Vehicle Park Sites �$5 H01GH1N Dq7F
rate Bondin In ion � $20
S ial Ins ection �$30 r Hour � �^�
S ial Ins 'on �$.31 r Mile ' � o'Z
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF T COMPLETED WITHIN 18 MONTHS
FOR OFFlCE USE ONLY
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Requ ate: Rough-in Inspection Hequired? ❑ Yes ❑ No Inspeclion OMer Than Rough-In: dy Now � Will Catl �
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You must call the inspector when ready! Date Ready:
I ceAify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspedion of the electrical work at:
Job Address (Street, x, or Route No.) Ciry Zp Code
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Section Township Range . Fire No. Counry n �
619 Coon R
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EB-00001A43
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Name Coryractor Lioense Number _ Masj�r License Number
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INSTpUCT10NS ON BACK OF YELLOW COPY