P - 78308REQUEST FOR ELECT�-FN6PECTION
�] Minnesota Board of Electriciry ��
1- 3 4� 2�� 1 O 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
_ (651) 642-0800 TTY/MRS 1-800-627-3529 -
www. electricity. state. mn. us
Identliy the work covered by this request:
❑ NEW ❑ REMODEL I�ADDITION ❑ REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am re (� $25
401 to 800 Am re �$50
Above 800 Am re � $75
CIRCUITS / FEEDERS
0 to 200 Am re (� $5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTflOL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each stem Device or aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
OTHER ADDITIONAL FEES
Lighting Retrofit � $25 per Fixture
Center Pivot Irrigation Boom �$40 7/� �
Manufactured Home Park Lots � S25 _
v ��--
Outdoor Li htin Standard � $1
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transfortners over 10 KVA � $20
Transformer / Power Su for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlw Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit (� $80
AddiGonal Inspection Trips � $20
Investiqative Fee
WR IMSPE
�
I herebv certifv that I insoected the electriral
total fee is
ates stated:
DATE
rate Bondin Ins 'on � $20 ^�Z .. �
S ial In 'on �$30 r Hour ''"�"'�"01 - o"T�
S ial In 'on �$.31 r Mile -�
THIS INSTALLATION MAY BE ORDERED DiSCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFlCE U� 0/0.Y � .Il ` / � �
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Request Date: Rough-in Inspection Required? �Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
/'' p'� � You must call the inspector when ready! Date Ready:
I certiiy that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
tt3-IMNlA-l'3 in�talo BOARD OF ELECTRICITY COPY INSTFiUCTION3 ON BACK OF YELLOW COPY