P - 78291REQUEST FOR ELECTRICAL INSPECTION
�� 3 5 7� L� 4 Minnesota Board of Electricity
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 ❑REMODEL ❑ADDITION �REPAIR 1
GENERAL FEES Outdoor Li htin Standard (� $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am re �$5 ..r_ ,F ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service andlor Power Suppty up to 500 Amperes, Ali
ALARM, COMMUNICATION, FEMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelli Unit (� $80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addftional Ins ion Tri �$20
Each S stem Device or aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to t2 Units �$5o Per Unit (minimum total fee is $20)
Each Additional Unit �$25 For+ ir+svECron use or��v
OTHER ADDITIONAL FEES �,�G�- /_ / � ��`
Li hti Retrofit �$25 r Fixture
CeMer Pivot Irti atlon Boom �$40
Manufactured Home Park Lots �$25 hereby certify that I inspected Me eiedrical installation described herein on the dates stated:
Recreational Vehicle Park Sites � $5 "01GN "' �T�
Se rate Bondin In ion �$20
S �al In 'on �$30 r Hour fl"^""�010N �T�
S 'al I ' � $.31 r Mile •� 2 � �' ��i
__ _THIS INSTALLATION MAY BE ORDERED DISCONNEC NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY '
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Request Date: Rough-in Inspeclion Required? ❑ Yes Jo , Inspection Other Than Fiough-In: eady Now ❑ Will Call
� �� You must call the inspector when ready! Date Ready: j ��
I certity that I am the [�CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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