P - 78152e REQUEST FOR ELECTRICAL INSPECTION
1� J O e� - 9 6 2� Minnesota Boarcl of Electriaty
1821 University Avenue Suite S-128, Sairrt Paul, Minnesota 55104
(651) 642-0800 T'fYlMRS 1-800-627-3529 www.e[ectricity.state.mn.us
❑ NE REMODE ❑ ADDITION ❑ R PAI Describe -using the bxk white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Liahtina Standard � St
2M, COMMUNICATION, REMOTE CONTROL,
;UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL F
iIFAMILY DWELLINGS (PER UNI�
3 to 12 Unils � y50 Per Unfl
Exh Additional Unit � E25
OTHER ADDITIONAL FEES
Lighting Retrofit @ $.25 per Fixtu2
Center Pivot Im ation Boom $
Manufactured Home Park Lots (�
Recreational Vehicle Park Sites . =5
Separate Bonding Inspection $20
Special Inspection � S30 per Hour
Special Irapec6on (d� 5.31 per AAile
Transformers u to 10 KVA $10
Transformers over 10 KVA �$ 20
Transfortner / Power Supply for Siqns I Outline Liqhtinq E5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Fee
Fee
(minimum total fee is $20) � SO $�
iH15 AREA FIXi INSPECTpi USE OPLY
I hereby cer6y Mat I inspecBed the elecbical instaN�on described herein on the da�s sta0ed:
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�/ Rough�n Inspection Required? Y ❑ No Inspection Other Than Rough-In: ❑Ready ��
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You must call fhe inspeda wFien readyl Date Ready:
t I am the ,�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of tlie electrical work at: