P - 78780� REQUEST FOR ELECTRICAL INSPECTION
1F - 3 4�- 319 � Minneso�a Board of Electriciry
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
- www.electricity.state.mn.us
fentify the work covered by this request:
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR � SGU/�%i N'? / OO / 1(
GENERAL FEES Outdoor Li Standard �$7
ERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
IRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li Mi �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service and�or Power Suppty up to 500 Amperes, All
LARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two In ection Tri s Each Dwellin Unit �$80
IRCUITS, CIFCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri �$20
Each S em Device or ratus �$.50 Investl tive Fee
ADDITIONS TO THE GENERAL FEES Rein 'on Fee �$20
ULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 UniGs �$50 Per Unft 5'
Each Additanal Unit � S25 ��� ���Y (minimum totai fee is $20) �. �
I Retrofd � $25 r Fature
Pivot Irri tion Boom �
Ctuf2d HOInB Pa1k LotS �$25 I he cerMy tliat I inspected the electrical inslallation desa�ed herein on tl�
ional Vehicle Park Sites � S5 �+�+
S al I ection �$30 r Hour ��T�+ ��
S ial In 'on �$ 31 r Mile g�'�77
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now Will Call
•��7 �� You must call the inspector when readyl Date Ready:
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY �OWNER and hereby request inspection of the electrical work at