P - 82008� REQUEST FOR ELECTRfCAL INSPECTION
�. 14 6 5 g 7� Minnesota Board of Electricity -
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OS00 TTYIMflS 1-800-627-35
www.electricity.state.mn.us � " `� '
Identify the work coveretl by this request:
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❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard C� $1
SERVICES / POWER SUPPLIES Traific Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transfortners u to 10 KVA �$10
Above 800 Am ere �$75 Transfortners over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su for Si ns ( Outline Li Gn �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Indudes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Tri s Each Dwellin Unit �$&0
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri �$20
Each S stem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES iieins 'on Fee (� $20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$50 Per Unit (minimum total fee is $20) ,
Each Additional Unit �$25 wn insrECra� use orar
OTHER ADDITIONAL FEES
Li htin RetroM �$25 r Fi�Rure
Ceoter Pivot Irri a6on Boom �`$40 '�
Manufadured Home Park Lots �$25 - � nereby ceniry mat � inspected me e�edrica� instauaGon described nerein on nie daces stated:
Recrea�onal Vehicle Park Sites � $5 '�"�"" °ATE
Se rate Bondin Ins 'on � $20
S ecial In tion �$30 r Hour ""`"1°�101 °ATE
S ecial In ection �$.31 r Mile w-�Z'�'U
`HIS INSTALLATION MAY BE ORDERED DISCONNECTED IF ___ OMPLETED WITHIN 18 MONTHS __
POR OFFICE USE ONLY
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Request Date: Rough-in Inspeclion Required? ❑ Yes No Inspection Other Than Rough-In: eady Now � Wltl Call
You must call the inspector when readyl Data Ready:
1 certiiy that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe elecUical work at:
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BOAHD OF ELECTFi1CIT' COPY WSTFiUCTIONB ON BACK OF YELLOW COPY