P - 80126REQUEST FOR ELECTRICAL INSPECTION
1 0 9 3 8 8 9 °� Minnesota Board of Electriciry
�+ � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
��, �e (651) 642-0800 TTY/MRS 1-800-627-3529
� www.electriciry.state.mn.us
Identify the work covered by this request:
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❑ NEW ❑ REMODEL ❑ ADDITION PAIR �/�'
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Tra�c Si nal Standard �$5
0 to 400 Am ere �$25 c� Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS I FEEDERS Transformer I Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two inspection Trips Each Dweilin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S stem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee C� $20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units ��50 Per Unit _ (minimum total fee is $20) _
FEES
Retrofit � $25 per Fixtu
'ivot Irtigation Boom � $
tured Home Park Lots �
onal Vehide Park Sites �
1 herebY�certitY that I inspected lhe electrical installatian �saibed herein
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THIS INSTALLATION MAY BE ORDERED DISCONNECTI
FOR OFFICE USE ONLY
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Request ate: Raugh-in Inspection Required? ❑ Yes o Inspecdon OU�er Than ugh-In:
QC 8 You must call the inspector when readyi Date Ready: S p�(J �
I cerf that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request insF
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of the electrical work at