P - 78323REGIUEST FOR ELECTRICAL INSPECTION
1 3 4 7 3 91 Minnesota Board of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� (651) 642-0800 T'fY/MRS 1-800-627-3529 =
www. electriciry. state. mn. us
Identify the work covered by this request:
�NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR �/�J %
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am re �$25
401 to 800 Am re�$50
Above S00 Am re � $75
CIRCUITS I FEEDERS
0 to 200 Am re �$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIACUITS OF LESS THAN 50 VOLTS
Each S em Device or A aratus f� $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each AddRional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fature
Center Pivot Irri aUon Boom �$40
Manufactured Home Park Lots �
Recreational Vehicle Park Sftes � $5
Se rate Bondi Ins 'on � $20
S 'al I ' � $30 r Hour
S ecial Ins ection �$.31 r Mile
THIS INSTALLATION MAY BE ORDERED DIS
FOR OFFICE USE ONLY
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Outdoor Li htin Standard � $1 �
Traific Si nai Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Odtline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspectlon Trips Each Dwellin Unit �$B(
Additional Insoection Trios � $20
Fee �
total fee is
linspectedthe electricalinstallafion described herein on the dates stated:
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Request Date: Fiough-in Inspection Required? Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now Will Call
(^y� Q You must call the inspector when ready! Date Ready:
I certity 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 Cade
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Section Township Range Fire No. unty
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Occupant � � ��� ' c�
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Po er Supplier Address
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Electrical Contrador / Company Name
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Mailing Address (Contrector, Company or Owner Performing Installation)
� Authorized Signature
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7/1/2000
Pno�e
License Number
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BOAHD OF ELEC7AIC(TY COPY
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INSTRUCT70NS ON BACK OF YELLOW COPY