P - 78986REQUEST FOR ELECTRICAL INSPECTION
1° 3 5 0°�� g � Minnesota Board of Electricity °°�
�� 1821 Unive�sity Avenue Suite S-128, Saint Paul, Minnesota 55104
` �"` �° (651) 642-0800 TTY/MRS 1-800-627-3529
� www.electricity.state.mn.us �
Identity the work coveretl by this request:
❑NEW ❑REMODEL ❑ADDITION ❑REPAIR
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� C.` �.'�Y„v 1j� 1 C�l. ti'� �. l
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Outdoor Li htin Standard � $1
Traffic Si nal Standard � $5
0 io 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transiormers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
UITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING , Circuits and Two Inspection Trips Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Insoection Trios �$20
Each S stem Device or ratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UN!
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES •
Li htin Retrofd (� $25 r Fi�Rure
Center Pivot Irri tion Boom �$40
Manufactured Home Park Lots � $25
Recrea6onal Vehicte Park Sites � $5
5pecial Inspection � $.31 per Mile
THIS INSTALLATION MA
�' Reins ion Fee �
FOR WSPECTOfl USE ONLV
� I herebvi cedi(v that I insoecte
FOR OFflCE USE ONLY
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(minimum total fee is $20)_J�>-
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the electricat installation described herein on the dates stated:
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I ceRify that I am the +`�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER arul hereby request inspection of the electrical work at: