P - 80544REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity -``
1!� 1 3�� 7 O 6 ' 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 ��;
www. electrcci ty. state. mn. us
Identity the work covered by this request: ^ ,(
❑ NEW ❑ REMODEL ADDITION p REPAIR �'�� °� O a�r M, r��� E'� UP � t
GENERAL FEES Outdoor Li h6n Standard �$1
SERVICES / POWER SUPPLIES - Traffic Si nal Standard �$5
0 to 400 Am re�$25 0 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 Transiormer / Power Su for S' ns / Outline Li htin �$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 Supply up to 500 Amperes, Ail
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Ins ion Tri s Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Adddional Ins ction Tri s�$20
Each em Device or ratus �$.50 Investi tive Fee
ADDITIONS TO THE GENERAL FEES Reins 'on Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 units �$5o Per Unit (minimum total fee is $20
EeCh AddftiOltal U�it �$25 FOq INSPECTOR USE ONLV
eC
OTHER ADDITIONAL FEES ��..,� Y � '
Li hti Retro�t �$25 er Fixture
Center Pivot Irri afion Boom �$40
ManufaCtur2d Home Pa�k LotS �$25 - I hereby ce�ify that I inspected ihe electrical installation described herein on the dates stated:
Recreational Vehide Park SRes �$5 P01�"'" °"'�
Se arate Bondin In 'on � $20 �`"—� �'"'Q �
�al Ins 'on � 330 r Hour """""�`"0" °"'�
S'al In an �$.31 r Mile ��`��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes o Inspectlon Other Than Rough-In: ❑ Ready Now Will Call
� You must call the inspector when readyl Date Ready:
I ceRity that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, B/ox, or Route No.) City Zip Code
//n / [� G � i.,_ ��75��c5,�s � �2 It� I P tn �`� J T� oL
I Section
� Power Supplier
�I Contract Company Name
Address (Contractor, Company Or
Fire No.
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ConVactor License Number Master License Number
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