P - 79546REQUEST FOR ELECTRICAL INSPECTION
�.` � 18 9 6 7 9 ;° Minnesota Board of Electriciry
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� � �� (651) 642-OS00 TTY/MRS 1-500-627-3529
` www.electricity.state.mn.us
IdentiTy the work covered by this request:
❑NEW ❑REMODEL ❑ADDITION �AEPAIR
GENERAL FEES
0 to 400 Am ere �$;
401 to 800 Am ere �
Above 800 Am ere �
CtRCUfTS / FEEDERS
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem �evice or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Lighting Retrofit � $.25 per Fxture
Center Pivot Irriaation Boom (� S4U
7 �'� \ �� �
Outdoor li htin Siandard � 1
Traffic Si nal Standard � $5
Su Iementai Fee � $20
Transformers u to 10 KVA (� $10
Transformers over 10 KVA � $20
7rar�sfortner / Power Su t for S' ns 1 Outline L' hti �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80 •
Fee �
TOTAL FEE r�
total fee is $20) ,
installation descn'bed herein on �e dates sta�d:
S ial Ins ' n�$30 r Hour �'�"°"' ��� �,3�` t I
Special Inspection � $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFlCE USE ONLY
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Request Date: Rough-in Inspection Requiredl ❑ Yes o Inspection O[her Than Rough-In: ady Now ❑ Will Call
�°/��� You must call the inspedor when reatlyl Date Ready: � Q
I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: