P - 78331REQUEST FOR ELECTRICAL INSPECTION
1 3 3 6 7 5 0 Minnesota Board of Electriciry —
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
• (651) 642-0800 T'fY/MRS 1-800-6273529
www.electricity.state.mn. us
Identify the work covered by this request ` !
�i��S�u! 1 u,-r.u.if �-�o ��w� cQ��fra.-� �
EW ❑ REMODEL ❑ ADDITION ❑ REPAIR �'
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Tra(fic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am re�$50 Trans(ormers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su for S' ns / Outline U h6n �$5
0 to 200 Am re �$5 p ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service andlor Power Supply up to 500 Amperes, Ail
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional In ion Tri s�$20
Each S stem Device or atus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinsoection Fee �$20
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Lighting Retrofit � $25 per Fixture
Center Pivot Irrigation Boom (� $40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites � $5
Separate Bonding Inspection � $20
S ecial Ins �on �$30 er Hour
total fee is
the electricalinstallatlon described herein on the
S ecial Ins ection �$.31 r Mile ���----�-�--�, 1--�� I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED NOT COMPLETED WITHIN 18 MONTHS
FOR OFFlCE USE ONLY
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Reque Date� Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: eady Now � Will Call
���V You must call the inspector when ready! Date Ready: ��� �
I certiiy that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) C' Zip Code
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Section Township Range Fire No. ounty
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Electrical Contrador / Com�any Name
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Mailing Address (Contractor, Company or
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idor License Number Master License Number
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IICITY COPY INSTRUCTIONS ON BACK OF YE