P - 81920REQUEST FOR ELECTRICAL INSPECTION
1_� ry 7. g 71 Minnesota Board of Electricity
J �.; 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�;� -� (651) 642-0800 TTY/MRS 1-800-627-3529
� www.electricity.state.mn.us ��
IdentiTy the work covered by this request: ����
pNEW ❑REMODEL ❑ADDITION REPAIR �� (���
GENERAL FE S Outdoor Li htin Siandard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re (� $25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above S00 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS I FEEDERS Transformer / Power Su I for Si ns I Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circu'ds and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOL7S Addftional Ins ection Tri s�$20
Each S stem Device or A ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee �$20
Center Pivot Irrigatiort Boom � $4
Manufactured Hane Park Lots �
Recreational Vehi�e Park Sites �
Separate Bonding Inspection � $�
Soecial Insoection � $30 cer Hou
total fee is $20) }}�.J � ;�
eledrical ir�slalladon descnbed herein on
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FOR OFFICE USE ONLY
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Request Date: Rough-in inspecEOn Requfred? Yes No Inspection Other Than Rough-In: dy Now � Will Call
� �'�, You must caN !he inspector when ready! Date Ready:
I cert'rfy that I am the NSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, x, or Ro e No.) City Zip Code
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Name Cor�j[ac[or License Number
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(Cordracror, C�mpany or Owner Perfortning Installation)
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License Number
BOARD OF ELECTAICITY COPY ����MISTFIUCTONS Wd BAC�F YFILOW