P - 79527REQUEST FOR ELECTRICAL INSPECTION
� � � � � - 7 � � a Minnesota Board of Electricity -�
��� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
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, ��„�°; (651) 642-OS00 TTYIMRS 1-800-627-3529
www.electricity.state.mn.us
Identify th Tk covered by this request:
EW ❑REMODEL ❑ADDITION ❑REPAIR ' '� ��'�"�`'�Y✓ � C�C�J�1` — �""— P� �
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transfortners u to 10 KVA (� $10
Above 800 Am ere �$75 Transtormers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer ! Power Su I for Si �s / Qutline Li hti �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere C� $10 Includes the Service andlw Power Suppfy up to 506 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additionai Inspection Tri s�$20
Each S stem Device or A ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinsnection Fee �$20 _
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htln Fetrofrt �$25 er Fixture
Center Pivot Irri aGon Boom �$4
Manufactured Home Park Lots �
Recreational Vehicle Park Sites �
Seoarate Bondina Insoection � 520
�iti1�%U.`►'lA 2�4 mi�mum total fee is $;
FOP INSPELTOq USE ONLY
I herehy cerU(y that 1 inspected tl�e eledncal ;nstallation described herein on tl
rroucH rc�
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETEO
FOR OFFICE USE ONLY
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Request �ate: � Rough-in Inspectlon Required? ❑ Yes Inspection Other Than Rough-Ip
18 MONTH;
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���/ l� (J� 6 L I You must call the inspector when readyl I Date Fieady: �,� (/N` �(jj'j'L �
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i certify ihat I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspectlon of the electrical work at