P - 81870�B�1C3-016 � �
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Identity the work covered by this request:
❑ NEW ❑ REMODEL ❑ADDITION ❑ REPAIR
0 to 400 Ai
401 to 800
Above S00
�UITS / FE
0 to 200 Ai
� $'
�e �
�
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity '—°�
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/M RS 1-800-627-3529
www.electricity.state.mn.us '� '
�% �� �� l ���-�885
Outdoor Li htin Standard � $1
Traffic Si nal Standard � $5
Su lementai Fee � $20
Transtormers u to 10 KVA �$10
Trensformers over 10 KVA � $20
Transformer / Power Su i for Si ns / Outline Li htin �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 500 Amperes, All
RM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Ins don Trips Each Dwelling Unit �$80
�UITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri �$20
Each S tem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins 'on Fee �$20
.TIFAMILY DWELLINGS PER UNI TOTAL FEE �
3 to 12 Units �$50 Per Unit (minimum total fee is $20)
Each AddiGonal Unit � $25 F°"'"S"ECr°" "s� °"��
OTHER ADDITIONAL FEES
Li htin Retrofit �$.25 r Fixture
Center Pivot Irri ation Boom �$40
�Manufactured Home Park Lots �$25 - I herebvi certiN mat I insoected me. electrical insml�6on des«ibed herein on the �tes
S ial Ins 'on �$30 r Hour "'"L°L1°" """
Special InspecUon � $.31 per Mile � ��' � �� �/
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN ?8 MONTHS'
FOR OFFICE I�E ONLY
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Request D�: O' Rough-in InspecUon Required? -❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now ill Call �
� �� You must call the inspector when ready! Date Ready:
I cetti(y that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: