P - 76382REQUEST FOR ELECTRICAL INSPECTION °`�"
1 820 275 4 �����
� e� ❑ 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 ���
Describe -using the back of the white copy if necessary - the work covered by this request: �
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GENERAL FEES Outdoor Lightin Standard $1
SERVICES I POWER SUPPLIES � Traffic Si nal Standard @$5
0 to 400 Am ere $25 Supplemental Fee $20
401 to 800 Am re $50 Transfortners u to 10 KVA $10
Above 800 Am ere $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns I Outline Li htin $5
0 to 200 Am ere $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Ampere $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circufts and Two Inspection T�ps Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s $20
Each S stem Device or A paratus $.50 Investi ative Fee
ADDITIONS 70 THE GENERAL FEES Reinsoection Fee na $20
MULTIFAMILY DWELLINGS PEI
3 to 12 Units @$50 Per Unit
OTHER ADDITIONAL FEES
Li htin Retrofit $25 per Fixture
Center Pivot Irri ation Boom $40
Manufadured Home Park Lots $25
Recreational Vehicle Park Sites $5
Se arate Bondin Ins ion $20
Special Inspection $30 er Hour
S'al Ins ion $.31 r Mile
THIS INSTALLATION MAY BE ORDERED
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18202754
TOTAL FEE I
total fee is $20) �� � �
I hereby certiTy that I inspecled the elecUical installation described herein on fhe dates stated:
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COMPLETED WITHIN 12 MONTHS
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Date: Rough-in Inspection Required? ❑Yes �No Inspedion OtherThan Rough-In: ❑ Ready Now ❑Will Call
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You must call the inspector when ready! � Date Ready:
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work ai
Job Site Sheet Address City
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Please Provide Two (2) Phone Nu bers Including Area Code
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