P - 78325REGlUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electriciry �
1- 3 4 7- 412 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TfY/MRS 1-800-627-3529
www.electricity.state.mn.us "�*'
Identity the work covered by this request: � /�� ,�� �� /�� 1
[ (� 4l/ 1r �'t G- (�✓Q
❑NEW REMODEL ❑ADDITION pREPAIR �
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Tra�ic Si nal Standard �$5 �
0 to 400 Am re �$25 Su lemental Fee (� $20
401 to 800 Am re �$50 Trans(ormers u io 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA (� $20
CIRCUITS / FEEDERS TransfoRner / 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 Supply up to 500 Amperes, All
AIARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellinq Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A paratus C� $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES __
Li htin Retrofit �$.25 er Flxture i
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots � $25 �
(� $30 per Hour
� $.31 cer Mile
Fee �
TOTAL FEE
totai fee is $201
that I inscected the electrical installalion described herein on the dates stated:
�-�-- �� �.. C� V I
FOR OFFICE USE ONLV
�Z�7�3
IIlIIIIIIIIIIIIilllllil111llllllllllllllllllllllli �����
�����41z�� �da��is�s
R uest Date: Rough-in Inspedion Required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now ill Call
�� � � You must call the inspector when �eadyl Date Ready: �
I certiiy that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: