P - 78319REQUEST FOR ELECTRICAL INSPECTION
� _ � � � - � � � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electrici ty. state. mn. us
IUemfry the work coveretl by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am ere �$25
401 to 800 Am re�$50
Above 800 Amoere � $75
0 to 200 Am ere �$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus (� $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional UnR � $25
OTHER ADDITIONAL FEES
� hti ReVOfit � $25 r Fixture
Center Pivot Irri tion Boom �$40
Manufactured Home Park Lots � $25
Recreational Vehide Park Sites � $5
Se arate Bondi Ins 'on � $20
S ial Ins ion �$30 r Hour
S' I In 'on �$.31 r Mile
THIS INSTALLATION MAY BE ORDERE�
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Su demental Fee � $20 � �
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer ! Power Su I for Si ns / Outline Li htl (� $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Ins ecGon Trips Each Dwellin Unit �$8(
Additional Inspection Trips � $20
Investiaative Fee
(minimum total fee is
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I hereb ceR' ihat I inspected the eleciriql insfallation described herein on ihe dates stated:
HOIM�IIIN � DRTE
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FOR OFFICE USE ONLY �
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Request Date: Rough-in Inspection Required? Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now Will Call
�'� O��y You must call the inspector when ready! Date Ready:
I certify 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 Zip C�
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Section Township Range Fire No. Coun
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Occupant r I�S //� s,�C"C C� Y �l Phone� �.` "`i /%G'����%
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Power Supplier Address
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Electrical Contrador / Company Name � A ontractor License Number Master License Number
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Mailing Address (CoMrac[or, Company or Owner Performing Installation)
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Authorized Sig re (C ctor, m an r Owner Perfortning Installation) Phone
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EB-OOOOtA- /2 BOApD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY