P - 78295REQUEST FOR ELECTRiCAL INSPECTION
% Minnesota Board of Electricity '�
1��� I- 3 6 4 �82� University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 T'fY/WiRS 1-800-627-3529 =
www.electricity.state.mn.us
Identity the work covered by this request:
❑NEW ❑REMODEL ADDITION ❑REPAIR /��v
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Su IemeMal Fee �$20
401 to 800 Am re�$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin (� $5
0 to 200 Am re � ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALAAM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelli Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ction Tri s�$20
Each S stem Device or aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins �on Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to �2 Un�s �$5o Per Unit (minimum total fee is $20) .
E2f�1 Additi0f121 U�it �$25 � ��PECTOq USE �r
OTHER ADDITIONAL FEES S� �� �
Li htin Retrofit �$25 r Fixture
Center Pivot I' a6on Boom �$40 �Z �,,�,�^
Manufactured Home Park Lots �$25 I he certily that I in ed the electricat installation described rein dFi ihe dates �fe�i
Recreational Vehicle Park Sites �$5 P01GH1N -,.w�
Se arate Bondin Ins tlon �$20 ^ S"Z �� C�
S ' I � $30 r Hour '"P'i "�0"�" ��
S'al I ' n�$.31 r Mile /�1 c� �
_ THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITH N'W�M NTHS
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required7 Yes ❑ No Inspection Other Than Rough-In: ❑ peady Now �II Cali
J P— ('�� � You must call the inspector when ready! Date Ready:
I certiiy that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY � OWNER and hereby request inspection of the electrical work at: