P - 79741��/�, ���.�,// REQUEST FOR ELECTRICAL INSPECTION
�7 �° Minnesota Board of Electricity
1� 17 4- 9 2 8 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
. (651) 642-0800 TTY/MRS 1-800-627-3529
www. e lectricity. state. mn. us
IdentiTy the work covered by this request: �� /� ��� ,L � (,�� y� �� �p�
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❑NEW EMODEL ❑ADDITION ❑REPAIR Q (.{/"��� � B�
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to S00 Am re �$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 re �$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' Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins 'on Tri s�$20
Each S stem Device or A aretus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units (� $50 Per Unit
EeCh Additi0f181 Unit C$25 FO" �"SP�O" �°NLV
OTHER ADDITIONAL FEES
Li htin Retrofd �$25 r Fixture
Center Pivot I' ation Boom �$40
Manufactured Home Park Lols �$2 I here ceruy that i i�
Recreational Vehicle Park Sftes � �0"'"
Se rate Bondin Ins ection �$20 �
S cial Ins ction �$30 er Hour �"'�"0"
S ial Ins ection �$.31 er Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF
FOR OFFICE USE ONLY
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total fee is
ir�talla6on described herein an the detes �ated:
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Request Date: Rough-in Inspection Required? Yes ❑ No In
spection Other Than RougMin: ❑ Ready Now II Call �
D�- You must call the inspector when ready! Date Ready:
I certfy that I a the �CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecVical work at
CH�UUOOIA'l3 7111'L400 BOARD OF ELECTRICITY COPY INSTFIUCTqN3 ON BACK OF YELLOW COPY