P - 79539REQUEST FOR ELECTRICAL INSPECTION
1� 2 b 4� V V� ,° �� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul Minnesota 55104
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Identify the work covered by this request:
❑ NEW $I.REMODEL ❑ ADDITION ❑ REPAIR
0 to 400 Ampere � $25
401 to 800 Ampere (� $50
Above 800 Ampere � $75
:UITS / FEEDERS � �
0 to 2� Ampere � $5
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTROL, SIGI
;UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
.TIFAMILY DWELLINGS (PER UNI�
3 to 12 Units (� $50 Per Unit
Each Additional Unit (� $25
OTHER ADDITIONAL FEES
Li htin Retrofit �$.25 r Fixture
Center Pivot Irrigation Boom � $40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites � $5
Separate Bonding Inspection � $20 �
Soecial Insoection � $30 qer Hour
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Outdoor Li htin Standard � $1
Traitic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Sup I for Si ns I Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$8(
Additional Inspection Trips � $20
Investiaative Fee
total fee is
desaibed herein on
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED I�A6T COMPLETED WITHIN 18 MONTNS
, FOR OFFICE USE ONLY
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Request Date: ^�'� Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now II Calt
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�'� � You muffi call the inspector when readyP Date Ready: �
i cerGiy that I am the�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the ele�trical wo�C at
EB-OOOOtA-13 7/1/2W0 BOARD OF ELECTRICRY COPY. INSTAUC710N3 ON BACK OF �ELLOw wv�