P - 77757� REQUEST FOR ELECTRICAL INSPECTION
/" Minnesota Board of clectricity�
J.. � 2 7 7- 5 9 3 �821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 - _
www. electricity. state. mn. us
Identi(y the work covered by this request:
❑ NEW ❑ REMODEL ADDITION ❑ REPAIR �� u`
GENERAL FEES Outdoor Li hGn Standard C� $1
SERVICES / POWER SUPPLIES i Traftic Si nal Standard �$5
0 to 400 Am re�$25 nCrea�se, Su lemental Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transfortners over 10 KVA �$20
CIR S/ FEEDERS Transfortner / Power Su for Si ns / Outline Li hti �$5
' 0 to 200 Am re �$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re�$10 Includes the Service andlor Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each em Device or araius �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES ' Rei bn Fce �$20 �
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 ro i2 un�s �$so aer unit (minimum total fee is $20) ��,.5 �
Each Additional Unit �$25 wp irsv�cTOR u� axv
OTHER ADDITIONAL FEES J4�— °V`��
Li hti Retrofit �$25 r Fixture �---�
Cemer Pivot Irti tion Boom �$40 K� � Z�•� '
ManuFactured Home Park Lots �$25 I ner ce that � inspected the electrical insta� described herein on the dstes scared: '
Recreational Vehicle Park SRes �$5 R01GH" ��
S rate Bondin Ins ection �$20 �-�lC^a�j
S �al In on �$30 r Hour p"°�"�°EC"°" c^,.� �„� �
S ' I ' � $.31 r Mile [��' �
_ THIS INSTALLAT�N MAY BE ORDERED DISCONNECT IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Request ate: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
� V� You must call ihe inspector when ready! Date Ready:
I certiiy that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No. City Zp Code
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Section hip Range Fire No. County
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Occupant Phone
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Power Supplier
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License Number Master License Number
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Mailing A�� ractor, Company r qwner Perfomi g Installation)
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Authoriz ignature (Con r or, Company or er PeAorming Installallon) Phone
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��O�A'�3 ����� BOARD OF ELECTRICITY COW INSTRUCTIONS ON BACK OF YELLOW COPY