P - 79849. REQUEST FOR EL��TRICAL INSPECTION
`� � � � � � � ° �� Minnesota Board of Electricity
� � e� • 1821 University Avenue Suite S-128, Saint P ul, Minnes��5104
�e,c� (651) 642-0800 TTY/MRS 1-800-627-3529 � ���„1
www.electricity.state.mn.us �
Identify the work covered by this request:
❑ NEW EMODEL ❑ ADDITION ❑ REPAIF
GENERAL FEES
0 to 400 Am ere �$25
401 to 800 Ampere � $50
Above 800 Ampere � $75
�UITS / FEEDERS
0 to 200 Ampere C� $5
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTROL, SIGNALING
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or A�oaratus �$.50
�.5� �5►-7�����78g�'
Outdoor Li htin Standard � $1
Traffic Si na1 Standard C� $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su for Si ns / Outline li htin (� $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuds and Two Inspection Trips Each Dwellin Unit �$8(
Additional Insnection Trips � $20
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fixture
Center Pivot Irri tion Boom �$40
Manufactured Home Park Lots � i hereby ceruhr that i
Reaea6onal Vehicle Park Sites � P01GH �'
Se arate Bondin Ins ection �$20
S cial Ins ection �$30 er Hour �"""�0"0N
S'al Ins ection �$.31 er Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED 1
FOR OFFICE USE ONLY
f������ ifi��f «��� 111I� i���� ����t i�i�� ��iii �M�r t��r
�E 1 3 O 7 5 O 2 3�E
total fee is
described herein on �he dates
� �d �� o
F NOT COMPLETED WITHIN 18 MONTHS
�� �I83 �p,S�
Request Date: Rough-in Inspection Required? ❑ Yes �No Inspection Other Than Rough-in: ❑ Ready Now ill Call
��'�O !i You must call the inspector when readyl Date Ready:
I certi(y that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspeotion of the elechical work at