P - 77173� REQUEST FOR ELECTRICAL NSPECTIO.�V Q
Minnesota Board of Electricity ��5 — Do!/o�0 -�
1� 3 4 7- 5 2 6 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 - -
www.electricity.state.mn. us
Identify the work covered by this request:
❑ NEW EMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am e�$25
401 to 800 A re �$50
Above 800 Am re � $75
CIRCUITS / FEEDERS
0 to 200 Am re �
Above 200 Am re� t0
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each stem Device or ralus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each AddRbnal Unit � $25
OTHER ADDITIONAL FEES
Li htin ReVOffi (� $25 r Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots � $25
Reaeational Vehi�e Park Siles � $5
S rate Bondn Ins 'on � $20
S �al Ins 'on � $30 er Hour
S ' Ins 'on � $.31 r Mile
Outtbor Li htin Standard � $1
Traific Si nal Standard � �5
Su emental Fee � $20
Transformers u to 10 KVA �$10
Transfortners over 10 KVA � $20
Transforther I Power Su for Si ns / Ou ine Li htin �$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 �$8(
Additional Inspection Trips � $20
Invesfiaative Fee
iviw� rcc �7
total fee is $20) /�
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i hereby cerGty that i inspected the electrical i fallalion described herein on tlre dates stated:
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FlNAL INSPE � DATE -
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF
FOR OFFlCE USE ONLY
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Request �• / Rough-in Inspection Required? Yes ❑ No Inspec
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Ready Now � Will Call
(p �� You must call the inspector when ready! Date Ready: �
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY �bWNER and hereby request inspection of the electrical work at:
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Seclion Township � Range Fire
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Occupen
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Power Supplier � ��� Address
� Mailing Address (Contract�Company or Owner Performing
No. County
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Phone /�/� � p /� �� /' v
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Contractor License Number Master License Number
Phone
BOAIiD ELECTRICRY COPY INS'TAUCTIONS ON BACK OF YELLOW COPY