P - 81643REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity ° ' �,
� � � �, � � �. � � �� 1821 University Avenue Suite S-1�28,-8aint Paul, Minnesota 55104 `�3
. i"��S (651) 642-0800 TTY/MRS 1-800-627-3529
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� ;�k } www.electricity.stute.mn.us
identify the work covered by this request �.
❑ NEW 0 REMODEL ❑ADDITION � (�] REPAIR � � � � �
GENERAL FE S Outdoor Li htin Standard �$1
401 to 800 Ampere �
Above S00 Am�ere �
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTROL, SIG.
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units �$50 Per Unit
Each Additional Unit (� $25
OTHER ADDITIONAL FEES
Center Pivot Irrigation Boom � $4(
Manufactured Home Park LoGS � $
Recrea6onal Vehicle Park Sites �
Separate Bonding Inspection � $2i
Soecial Insoection � $30 cer Hour
TraHic Si nal Standard � $5
Su lementai Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transtormer / Power Su I tor S' ns / Outline Li ti �$5
ONE & TWO FAMILY DWELLWGS, EACH UNIT
Indudes the Service andlor Power Supply up to 500 Amperes, Ali
� Circuits and Two Inspection Trips Each Dwelling Unit �$8(
Addftional Ins ction Trips � $20
Investivative Fee
total fee is
lhat I insoected the electrical installatlon described herein on the dates
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FOR OFFICE USE ONIY
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R uest Date: f Raugh-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: ' Ready Now 0 wR Cell
�� —� �—���� You must ca11 Me inspecror when readyl Date Ready: ;� �-��� — �.�i
I ceAify that I am the�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspeclion of the electricai work ffi:
Job Address (Street, Box, or Route No.) Cily r Zip Code
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Supplier �
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Mai�ing Address
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