P - 78811REQUEST FOR ELECTRICAL INSPECTION
.. Minnesota Board of Electriciry —
,
� � � � � � � � O � � �� 1827 University Avenue Suite S-128, Saint Paul, Minn sota 55104 �� �
, (651) 642-0800 TTY/M RS 1-800-627-3529 �j �
www.electricity.state.mn.us �
Identity the work c vered by this request: (jC �(,��..
❑ NEW EMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemer�tal Fee �$20
401 ro 800 Am ere �$50 Trar�sformers u to 10 KVA �$10
Above 800 Am re �$75 Transiormers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su for Si ns / Outline ' htin �$5
0 to 200 Am re � � ONE � TWO FAMILY DWELLINGS, EACH UNR
Above 200 Am re �$t Includes the Service andlor Powe� Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Tri s Each Dwelli UnR �$SO
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20
Each S tem Device or ratus �$.50 Investi ative Pee
ADDITIONS TO THE GENERAL FEES Rein ion Fee �$20 ____ ��^
3 to 12 UniGs �$50 Per Und ,.......°.--' -- — ',
Each AddRional Unit �$25 F0� �"�`� � a`Y
OTHER ADDITIONAL FEES
Li hti ReVofit �$25 r Fixture
CeMer Pivot I' ation Boom �$40
Manufactured Home Park Lots �$25 I he certily that I inspected tYre eledrical installaton descr�ed t�er�n on tlie ��ated�
o��
RecreaUOnal Vehide Park Sites �$5 p0U0H �'
S te Bondin Ins 'on � $20 �„�
S'al Ins ection �$30 r Hour `� �0N 7 2/^
S ial In bn �$.31 r Mile
_ THis INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFlCE USE ONLY
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Request Date: Rough-in Inspection Required? � Yes In ion Other Than R
f spec£ ough-In: ❑ Ready Now Call
J� Z �� Yo must call the inspector when readyl Date Ready:
I certity that I am the ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: