P - 80095REQUEST FOR ELECTRICAL INSPECTION
��� �� Minnesota Board of Electriciry -
1��� O� O 7 9 �°, 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
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��� .� (651) 642-0800 TTY/MRS 1-800-627-3529
www. electri ci ty. state. mn. us
ntify the work covered by this request:
NEW �'REMODEL ❑ADDITION ❑REPAIR
VICES / POWER SUPPLIES
0 to 400 Ampere � $25
401 to 800 Ampere � $50
Above 800 Ampere � $75
:UITS / FEEDERS
0.�200 Ampere � $5
Above 200 Ampere � $16
RM, COMMUNICATION, REMOTE CONTROL, SIGNALING
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
Each Additional Unft � $25
OTHER ADDITIONAL FEES
Lighting Retrofit � $25 per FuRure
Center Pivot Irrigation Boom � $40
Manufactured Home Park Lots � $25
Outdoor Li htin Standard � $1
Traffic Si nal Standard � $5
Su lementai Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
fncludes the Service andlor Power Supply up to 500 Amperes, Ail
Circuits and Two Inspection Trips Each Dwellin Unit �$8(
Additionai Ins ection Tri s�$20
Investl atNe Fee
Reinsnection Fee � $20
(minimum total fee is $20
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I hereby ceNy tl�at I inspected the electrical instal�tion desaieed herein on Me deles slated:
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S ecial Ins 'on �$30 r Hour FIW1L INSPECTIIXd ��
S ial Ins ion �$.37 Mile �� G
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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R uest Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
� e�I �� You must call the inspector when readyl Date Ready:
i certiiy that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of tlie elechical work at