P - 80107REQUEST FOR ELECTRICAL INSPECTION
°� Minnesota Board of Electricity
1� 3 2 6- 9 2 2 �� 182� University Avenue Suite S-128, Saint P(�ul, Minn sota 55104
� �� ee: (651) 642-0800 TTY/MRS 1-800-627-3529 � �� '
www.electricity.state.mn.us � `'�'
Identiiy the work covered by this request:
❑ NEW REMODEL ❑ ADDITION ❑ REPAIR � C�,U�MC� U f � t � � � U
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee d$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
IRCUITS / FEEDERS
0 to 200 Am re�$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$•50
ADDITIONS TO THE GENERAL FE
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Unfts �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li hti Retrofit �$25 er Fixture
Center Pivot Irri tion Boom �$40
Manufactured Home Park Lots � $25
Recreational Vehide Park Sftes � $5
Seoarate Bondina Insoection � $20
Transformer / Power Su for Si ns / Outline Li hti �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$80
Additional Ins ction Tri � $20
Investi ative Fee
Reins ion Fee � $20
TOTAL FEE �
(minimum total fee is $20)
FOA INSPECTOH USE ONLY
I herebvi ceAi(v that I inspected the electrical insfallation described herein on Ihe dates steted:
THIS INSTALLATION MAY BE ORDERED DISCONNECTE� NOT COMPLETED WITHIN 18 MONTNS
FOH OFFICE USE ONLY
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Request ate: �� Rough-in Inspection Aequired? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now Will Call _
� You must call the inspector when ready! Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe electrical work at
Job Ad ress (Street, Box, or Route No.) City Zip Code
i 32-
Section Township Range Fire No. County
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Master License
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E&OOOOtA-13 7/1/2000 BOMD OF ELEC7RICITY COPY NdSTRUCr10MS ON BACK OF YEILOW COPY