P - 78379REQUEST FOR ELECTRICAL INSPECTION
�° Minnesota Board of Electricity �` `
1- 3 4 7- 3 3 5 � 9 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�°�e� (651) 642-0800 TTY/MRS 1-800-627-3529 � � �
` www.electricity.state.mn.us
Identify the work covered by this request: �
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR / �
GENERAL FEES Outdoor Li htin Standarcl �$1
0 to 400 Ampere � $25 /� ('i',
401 to 800 Ampere � $50
Above 800 Ampere � $75
�UITS / FEEDERS
0 to 200 Ampere � $5 �!�G
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTROL,
CUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL F
3 to 12 Units �$50 Per Ur
Each Additanal Unit � $25
OTHER A[
Liqhtin� Retrofit � $25 per
Cemer Pivot Irrigation Boom
Manufactured Home Park Lc
Recreational Vehicle Park S
Hour
Traffic Signal Standard �
Supplemental Fee � $20
Transformers up to 10 KV
Transfortners over 10 KVI
Trensformer / Power Supply for Signs / Outline LigMing �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspecction Trips Each Dwellin Unit �$8(
Additional Inspection Trips � $20
Investiaative Fee
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total fee is
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I inspected the eledrical instaAation described herein on fhe da�s stated:
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF HOT COMPLETED WITHIN
FOR OFRCE U8E ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes o Inspeclion Other Than Rough-In: Ready Now II Call
'� � V•� You must call the inspector when ready! Date Ready:
I certi(y that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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BOAflO OF ELECTRICITY
Master License
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