P - 79573REQUEST FOR ELECTRICAL INSPECTION
�� L� 3- 3 3 3 � a� Minnesota Board of Electriciry
A� 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
. �" ' (651) 642-0800 TTY/MRS 1-500-627-3529
www.electricity.state.mn.us '� '
Identity the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR i�'.4 C r�� i,
GENERAL FEES Outdoor Liahtina Standard �$1
0 to 400 Am ere �$25
401 to 800 Am ere �$50
Above 800 Ampere � $75
CIRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE GONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or aratus �$.50
ADDITIONS TO THE GENERAL f
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unii
Lightlng Retrofit � $25 per Fixture
Center Pivot Irrigation Boom � $4f
Manufactured Home Park Lots � $
Recreational VehiGe Park Sites �
� $30 per Hour
(� $.31 cerMile
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unil �$8t
Additional Inspection Trips � $20
Investiaative Fee
tOk11 f2E IS
I hereby certity that I inspected the electrical installalion described herein an the dates stated:
RqN�lIIN DAIE
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FlNAI INSPEC710N ORE
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THI$ INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITH 11N 8 Niu ��
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? �� Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now II Call
y— �� Q� You must call the inspector when ready! Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at