P - 78724RE(�UEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity �"
1�� 4 6� 5 7 5 °� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
��°_� (651) 642-0800 T'fY/MRS 1-800-627-3529
� www.electricity.state.mn.us
Identity the work covered by this request:
❑NEW REMODEL ❑ADDITION ❑REPAIR ���`� � �� �� ��`�''"
GENERAL FEES Outdoor Li htin Standard �$t
SERVICES / POWER SUPPLIES Traific Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am ere f� $50 Transformers u to 10 KVA (� $10
Above 800 Am re�$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su for Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE 8� TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circufts and Two Ins ion Trips Each Dwelli Unit �$8(
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS A�itional Ins ion Tri s�$20
Each S stem Device or A aratus �$.50 Investi tive Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee �$20
Each Additional Unit �
Center Pivot Irtigation Boom � $
Manufactured Home Park Lots �
� $30 per Hour
� $.31 oer Mile
I in�ected the ele�trical installation
total fee is
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Request Date: Raugh-in Inspectian Required? es o Inspection Other Than Rough-In: ❑ Ready Now Will Call
� � You must call the inspector when Date Ready:
I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: