P - 78196REQUEST FOR ELECTRICAL INSPECTION
���O 7— 9 5 4 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
❑ NEW REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back o� Re copy'rf necessary - the work covered by ihis request
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GENERAL FEES Outdoor Li htin Standarcl S1
SERVICES I POWER SUPPLIES TraRc S' nal Standard $5
0 to 400 Amcere � E25 /�t� w �r,y, c�m,ioRw�r� F� � c�n
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENfRAL FEES
2 UniLc � y50 Per Unit
Additionai Unit @ $25
OTHER ADDITIONAL FEES
ng Retrofit @ $.25 per Fixture ,
�r Pivot Irri alan Boom yb0
factured Home Park Lots � $25 ,
atio�al Vehicle Park Sites � a5
rate Bonding Inspection $20
al Inspection (n1230 cer Hour
� Transtormers over 10 KVA � y 20
� Transfortner I Power SuDply for Signs I Outline LighGna $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspec6on Trips Each Dwelling Unit @$80
Reins tion Fee $20 ��tl v( //V.S
TOTALFEE
(minimum total fee is $20)
TNIS �REA Fdt INSPECiOR lISE pllv
I hereby certiy that I inspected the electrical installa6on descnbed herein on the dates sfafed:
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�e� Rough-in Inspection Required? Yes ❑ No Inspedion Other Than 12ougMn: ❑Ready Now II Cal�
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You must call the inspector when ready! Date Ready:
I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of tlie electrical wo�ic at:
ddress (Strreet. Box a Route No.) Ciry Zip Code
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