P - 78312REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electriciry l"`
1� 3 4.7 - 4 3 3 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 cover y this request:
❑ NEW EMODEL '� ADDITION ❑ REPAIR ��i '-v I—
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Su emenTal 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 Trar�sfortner / Power Su for Si ns / Outline Li h6 �$5
0 to 200 Am re�$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service and/or Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelli Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri �$20
Each S tem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE �ENERAL FEES Rein ' n Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to �2 units �$5o Per Unit (minimum total fee is $20)
Each Additanal Unit �$25 F°" i"s��T°" �sE °"�v p �
OTHER ADDITIONAL FEES �;cJ Y[i �I � I
Li htin Retrofit �$25 r Rxture �y a-� CL,��`
Center Pivot Irri tion Boom �$40 � /` �
Manufactured Home Park Lots �$25 I hereby ce ' that I in ed the electrical installafion described hefei� thg"daies ted:
Recreatlonal Vehide Park Sites �$5 "01f�' W � DA1E
Se arate Bondin Ins tion �$20 Y-�----r�°L} -� G
S ial Ins ion �$30 r Hour `*"` "�Q"0N G�
S ' I ' n � $.31 r Mile '�—�� % � ��° �,�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED W IN 1 S
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
You must call the inspector when ready! Date Ready:
I certity that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: