P - 79559REQUEST FOR ELECTRICAL INSPECTION
� :; Minnesota Board of Electricity "�
1���� 1� 2 1 O e° �° 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
°� a (651) 642-0800 TTY/MRS 1-800-627-3529� ��
� www.electricity.state.mn.us '' '
ldentify the work covered by this request:
❑NEW REMODEL ❑ADDITION ❑REPAIR —77�" ` 0 � S
GENERAL FEES Outdoor Li htin Standard �$1
401 to 800 Am ere �$50
Above 800 Am ere � $75
IRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIfiCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A ralus �$.50
ADDRIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fi�Rure
CeMer Pivot Irriaation Boom � $40
Traffic Si nal Standard � $5
Su demental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power 5u I for Si ns / Outline Li htin �$5
ONE � TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$SC
Additional Insoection Trios � $20
Fee
total fee is
I insoected the electrical insfallation described herein on tlie dstes stated: I
S ecial In ion �$30 er Hour F1'"""'""''""' �� _n_ I
S ecial Inspection �$.31 _per Mile �'— ��� Z
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOH OFFICE USE ONLY
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Request Date: Rough-in InspecUon Required7 ❑ Yes No InspecGon Other Than Rough-In: ❑ Ready No ill Call
�� You must call the inspector when reatly! Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecGon of the electrical work at
Job Address (Street, Box, or Route No,) City Zip Code
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Of ELECTRICRY COPY INSTpUCTt01� ON BACK OF YELLOW COPY