P - 78504REQUEST FOR ELECTRICAL INSPECTION
� Minnesota Board of Electriciry �
�� 3 4 7- 4 3 7 1821 �n��e�s��, A�e��e S��=e S-,2s, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. state. mn. us
Identity the work covered by this request: �_
❑ NEW ❑ REMODEL ADDITION ❑ REPAIR�� � �
GENERAL FEES Outdoor ' hd Standard �$1
S VICES / POWER SUPPLIES Tratfic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fce �$20
401 to 800 Am re �$50 Transformers u to 70 KVA �$70
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su fa Si ns / Outline Li htin �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re�$10 Includes the Service andlor Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Tri s Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addidonal In ion Tri s�$20
Each tem Device or ratus �$.50 Investi tive Fee
ADDITIONS TO THE GENERAL FEES Reinscection Fee �$20 5�
OTHER ADDITIONAL FEES � v D LL— U o� �' � a�'
Li htin Retrofit �$25 r Fature
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots �$25 I hereby ceAity Maf � inspected tne elecUical installation des�ibed heiein on tne �tes atsted:
RecreaUonal Vehi�e Park Sites � $5 "01G1'" °ATE
Se rate Borniin In 'on � $20
ial In 'on �$30 r Hour A""" °"'�
S ial In 'on �$.31 r Mile ��
��_THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
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FOR OFFICE USE ONLY �%'N (p"7' S( _
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Request Date: Rough-in Inspection Required7 ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now ill Call
Z �� You must call the inspector when ready! Date Ready:
I certity that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY �WNER and hereby request inspection of the electrical work ak