P - 79794REQUEST FOR ELECTRICAL INSPECTION
1 3 5 8 H 2 2 Minnesota Board of Electriciry
� � �° 9 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� ,� �°� (651) 642-0800 TTY/MRS 1-500-627-3529
t' www.electricity.state.mn.us "�'
Identity t e work covered by this request:
�uEyy ❑REMODEL ❑ADDITION ❑REPAIR \l V Iyl � C S �� ���
GENERAL FEES
IVICES I POWER SUPPLIES
0 to 400 Ampere � $25
401 to 800 Ampere � $50
Above S00 Ampere � $75
CUITS / FEEDERS
0 to 200 Ampere � $5
Above 200 Ampere � $10
iM, COMMUNICATION, REMOTE CONTROL, SIGNALING
;UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
TIFAMILY DWELLINGS PER UNI
3 to 12 Units (� $50 Per Unit
Each Additional Unit � $25
ut or Li htin Standard �
Tra�c Si nal Standard � $5
Su lemental Fee � $20
Transfortners u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I tor Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
CircuRs and Two Inspection Trips Each Dwellin Unit �$8(
Additional Ins ection Tri s�$20
Investi ative Fee
Reinsoection Fee � $20
, / s.3� c�-
total fee is
Li htin ReVofd �$25 er Fucture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots �$25 I hereby certiy that I inspected the electrical insfallation described herein on the dates s�ted:
Recreational Vehicle Park Sites �$5 �M IN a�
Se arate Bondin In 'on � $20
S ial In 'on �$30 er Hour "�10N ��
S ecial Ins ection �$.31 er Mile _�23
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WI'fHIN 18 MONTHS
FOR OFFICE USE ONLY
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qeg�s D te: Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now Will Call
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L You must call tlre inspecYor when ready! Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
JQb Addres�(Stre�t_Box, or Route No.) � � y �� City � � �� Zp Code ��
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Cont or License Number
istallati
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ing InstallaC n
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BOARD O LECTRICRY COPY
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Master
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INSTAUCTIONS ON BACK OF YEI.LOW COPV