P - 80543REQUEST FOR ELECTRICAL INSPECTION
1� 16 8- 417 Minnesota Board of Electriciry —
1821 University Avenue Suite S-728, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 =
www. electrici ty. state. mn. us
Identi(y the work covered by this request: �
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 4� Am re �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am re�$75 Transfortners over 10 KVA �$20
CIRCUITS / FEEDERS Trans(ortner / Power Su for Si ns / Outline Li htin �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Inciudes the Service and/or Power Supply up to 500 Amperes, Ali
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Ins ction Trips Each Dwelli Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional In 'on Tri s(� $20
Each S stem Device or ratus �$.50 Inves6 ative Fee
ADDITIONS TO THE GENERAL FEES Reins n Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE r�1
3 to 12 Units �$50 Per Unit (minimum total fee is $ J C/
Each Additlonal Unit � $25 F011N�0T0fl � °NL1
OTHER ADDITIONAL FEES
Li htin Hetrofit �$25 er Fixture
Center Pivot Irri ation Boom �$40
ManufaCtured Home Park Lots �$25 I hereb ceAiry that I i ed ihe electrical installalion described herein on ihe dates stated:
Recreational Vehicle Park Sites � $5 �"�"'" �T�
ce„�.s�e a,.,a�.,., i..�..�,...,..., sa con ,
�$30 per Hour �- � o��
sxav: �cnon
� $.31 oer Mile � �� �'Z.
� n�s �na � w�w � �c�n Mwr BE vRDERED D15CONNECTED IFI�OT COMPLETED WITHIN 18 MONTHS
FOR OFFlCE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: Ready Now ❑ Will Call
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' C� / You must call the inspector when readyl Date Ready:
I certi(y that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Bo , or ute No Ciry�I � Zp Code
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Sec[ion Township Range Fire No. County � ,
3or mpany Name
ELEGTRIC,
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ds. MN 5543�
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Address r
Contractor License Number
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3rforming Installatian)
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BOMD OF ELECTRICRY CpPY
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Master License Number
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