P - 79751REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1-396-559 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �`
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. sta te, mn, us
Identity the work covered by this request:
X XCE� ENERCiY SAVER'S SWITCH
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traific Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transfortners / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit �$80
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS Additional Inspecfion Trips �$20
Each System Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee �$20
MULTIFAMILY DWELLINGS PER UNIn TOTAL FEE •
3 to 12 Units �$50 Per Unit (minimum total fee is $20)
Farh Arirlitinnal I Init � 49S PoR INSPECTOF USE ONLY
Manufactured Home Park Lots �$25 � i nereey carmy ma� i��s�,ec�ea me eiec�r�i ��mi�am� aescnoed nere�n on ma de�es �ce
Recreational Vehicle Park SRes �$5 ROUGH IN on�
S rate Bondin Ins 'on � $20
S ecial InS 'on �$30 per Hour FINpL INSPECTION OATE
SpeCi81 If1Sp2Cti00 � $.31 pef MIIB ����-3' ` — � � '
FOR OFFICE USE ONLY
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* 1 3965595* � ��So
Reque Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-in: Ready Now ❑ Will Call
You must call the inspector when ready! Date Ready:
I certify that I am the I� LICENSED CONTRACTOR � COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
CO'�`^^""'" ����� BOARD OF ELECTRICITV COPY INSTRUCTIONS ON BACK OF YELLOW COPY