P - 76092REQUEST FOR ELECTRICAL INSPECTION
�� 9������ a Minnesota Board of Electricity
1821 University Avenue Suit S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY 0-627-3529 www.edectricity.state.mn.us
D�ribe -using the ba� af the white copy'rf ne�,sary - the work covered by this :
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GENERAL FEES Outdoor Liahfmn Standard C� $7
Above 800 Am re $75 Transformers over 10 KVA $ 20
;UITS / FEEDERS Trensformer I Power Su I for Si rrs / OuUine Li htl $5
0 to 200 Am re$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above Z00 Am re$10 � Includes the Service and/or Power Suppty up to 5�0 Amperes, A�
tM, COMMUNICATION, REMOI'E (:OPITROL, SIGNALING Circuits a� Two Inspection Trips Each Dwellim,� Unit @$80
;UITS, CIRCURS OF LESS THAN 50 VOLTS Additional Ins 'on Tri $20
Each S m Device orApparatus @$.� Investi ' Fee
ADDRIONS TO THE GENERAL FEES Reins 'on Fee $20 p ?
iIFAMILY DdVELLINGS PER UN TOTAL FEE
3 to 12 Units @$5o Per Unit (minimum total fee is $20) p� �,,�
Each Addi�onal Unit @ $25 ��1F�IPISPE�TURII�O�Y
OTHER ADDRIONAL FEES
ii9 � Retrafit@$25perFedure -- . .�-- . _ � . _ . Itrereby�rtlrytl�atlh�COedtheelearicalinslanatlortdes�xtbedF�inar�daBessmted:.-.-
CeMer Pivot Irzi on Boom @$40 R01tl1 a °ATE
Manufactured Home Park Lo1s $25
R�aifonal Vehicle Park Sftes $5 �"�' °ATE
Se eBondin Ins on $20 �—�°' �
Saecial Ir�s�ctlon (dt $30 oer Hour °�0/� °A7E —�
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�� Raugh-in Inspectlon R�uired9 ❑ Yes ,e(No Insp�tion Other Than Rough-In: 0 Ready Now,�MA Gall
�` ���� iP You must cell the inapector when readyl Date Ready:
I c�rtify that I am the ❑ LICENSED CAMRACTOR ❑ CORAPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Addreas Cfly �
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itrac�pr or er Perto 'o Plea� Provide Two (2) Ptrone Numbers Including Area Code
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