P - 78093REQUEST FOR ELECTRICAL INSPECTION
1`, �� C., � O/� �� Minnesota Board of Electriciiy
�� `* 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electriciry.state.mn.us
❑ NEW ❑ REMODEL ADDITION EPAIR Describe -usinq t back of the white copy if necessary - the w covered by this request:
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GEN L FEES Outdoor Li htin Standard $1
SERVICES I POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Am re$25 Su lemental Fee $20
401 to B00 Amcere � S50 Tra��tr,r�oa� ��� m�n uvc rn a�n
0 to 200 Am ere $5
Above 200 Am ere �$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or aratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Li htin Retrofit $.25 er Fi#ure A
Center Pivot Im a6on Boom $40
Manufactured Home Paric Lots $25
Recreational Vehicle Park Sites $5
Se arate Bondin Ins 6on $20
S ial Ins tion $30 r Hour
S ial lns fion 5.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCONN
IIIII (IIIIII�II IIIII IIIII IIi�IIIIII�III �� I�.
15350432.
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes lhe Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$BO
Reins tion Fee $20
TOTAL FEE
(minimum total fee is $20)
iH15 ARFA Fqi IIWECTIXi USE pdv
I hereby cer6fy Mat I inspected the electricat installa6on described herein on the dates stafed:
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K� t uate: Rough-in Inspection Required? ❑ Yes �No Inspedion Other Than Rough-In� Ready Now ❑ Wfll Call
You must call the inspedor when ready! Date Ready:
I cerhfy that I m the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at::