P - 80120REQUEST FOR ELECTRICAL INSPECTION
� 3 3 6 8 0 3 �� Minnesota Board of Electricity "�
� � � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
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� ��� (651) 642-0800 lTY/MRS 1-800-627-3529
www. electri ci ty. state. mn. us
Identity the work covered by this request:
❑ NEW ❑ REMODEL ❑ADDITION
0 to 400 Ampere � $25 :10��6/
401 to 606 Ampere � $50
Above 800 Ampere � $75
CUITS 1 FEEDERS
0 to 200 Ampere � $5 -.cc�
Above 200 Ampere � $10
RM, COMMUNICA710N, REMOTE CONTROL,
CUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE �ENERAL F
3 to 12 Units �$50 Per UnR
Each Additionai Unit � $25
OTHER ADDIT�ONAL FEES
Lighting Retrofit � $25 per Fixture
Center Pivot Irrigation Boom � $40
Manufactured Home Park Lots � $25
Recreational Vehi�e Park Sites � $5
Seoarate Bondi�a Insoecdon � $20
2c� k O�e� e� Se�v� cc �- 7�x � 5��
S�lZ v�'C� U`�6 2�1 D�� Q
Outdoor Li htin Standard � $1
Traffic Si nal Standard � $5
Su lemenial Fee � $20
Transiormers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer I Power Su f for Si ns / Outline Li htin �$5
Q—� ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
IGNALING Circuits and Two Inspection Trips Each Dwelling Unit �$80
Fee �
total fee is
that I insnected the eiectrical installation descrihed herein on tlie dazes
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Special lnspection �$ 31 per Mile --� "' ���' �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
WR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes No Inspec[ion Other Than Rough-In: ❑ Ready Now Will Call
��~0 � You muat call fhe inspector when readyl Date Ready:
I certi(y that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecUon of the electrical work at