P - 78635_ REQUEST FOR ELECTRICAL INSPECTION
1 315 5 6 9 � m Minnesota Board of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us
Iderrtiiy the work covered by this request:
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR „'��1"`�+C �.�GS LT1 G�
GENERAL FEES Outdoor Li htin Standard �$1
S VICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 (� Su lemental Fee �$20
401 to 800 A re f� $50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su for Si ns / Outline Li hd �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re�$10 Indudes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Tri Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additlonal In an Tri s�$20
Each stem Device or A ralus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins 'on Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$50 Per Unit (minimum total fee is $20)
Each Addltlonal Unit (�3 $25 FO"""sP`�0�'� °��
OTHER ADDITIONAL FEES � ' �
Li htin Retrofit �$25 r Flxture
Center Pivot Irri ation Boom �$40
Manufaclured Home Park Lots �$25 I hereby certity that I inspected tlie elechical i�ataHation described herein on the detes �ted:
Recreational Vehicle Park Sites � $5 "01�"" °�'�
arate Bondi In ion � $20
S ecial Ins ection �$30 er Hour """'"�701 °�'�
S ial Ins ection �$.31 r Mile _� `
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF T COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Requ Date: Rough-in Inspection Required? ❑ Yes ❑ Na Inspection O[her Than Rough-In: ❑ Ready Now 0 Will Call
1�J (� You must call the inspector when readyl Date Ready:
I certi(y that I am the�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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Authorized i ture (Contractor, Company or Owner Pertorming Installation Phone
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E&00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTpNB ON BACK OF YELLOW COPY