P - 79872REQUEST FOR ELECTRICAL INSPECTION
(�/� Minnesota Board of Electricity ""
1��-�J "t � 5 4 3� 1521 University Avenue Suite S-128, Saint Paul, Minnesota 55104
��-"��` (651) 642-0800 TTY/MRS 1-800-627-3529
. •,�! •'
www.electricity.state.mn.us
IdentiTy the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR I�C�/ "C�-� I I C L� .
GENERAL FEES Outdoor Li htin Standarcl C� $f
SERVICES / POWER SUPPLIES Tratfic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
4Qt to 800 Am ere �$5U Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
IRCUITS I FEEDERS Transformer / Power Su I for Si ns I Outline Li htin �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Senrice and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ction Tri �$20
Each S em Device or A ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ectioi
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units C� $50 Per Unit
EaCh Addltional Unit �$25 FOR INSPECTOP USE ONI
OTHER ADDITIONAL FEES �,�,J_
Li htin Retrofit �$25 r Fbcture ��
Center Pivot I' aGon Boom �$40
Manufactured Home Park Lots �$25 I hereby � diat
RecreaGonal Vehicle Park Sites �$5 p01�"'"
S te Bondi In ectia� �$20
S ecial Ins e�tion �$30 r Hour F'""` "�"�"0N
ial In ' � $.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED I
FOR OFFICE USE ONLY
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I cer�ty that I am the
Job Address (Street, ox, or
Power Supplier
Electrical ntractor /
W
Mailing Add (Cort
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Authoriz Signature
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E6-0O�OtA-13 7/tl2�00
(minimum total fee is $20�(,J_i
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al i�utadlatlon de�ribed herein on tlie �es s�ed:
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i WITHIN 18 MONTHS�_ _
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Rough-in Inspection Required9 ❑ Ye� Inspectfon Other Than Rough-In: Now ��II Cali
You must call the inspector when readyl Date Ready:
�1SED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Range Fire No.
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License Number
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BOAHD OF ELECTH1CT/ V NlSlAUC710NS ON BACK OF VELLOW COPY