P - 79804REQUEST FOR ELECTRICAL INSPECTION
� �_], % �� °� Minnesota Board of Electricity ���°
1� L'' 1 8� 1 3� �� �; 182y University Avenue Suite S-128, Saint Paul, Minnesota 55104
, 3� ��� (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us
Itlentify the work covered by this request:
❑ NEW �IEMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Ampere � $25
401 to 800 Am re (� $50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
O to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SP
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A ratus �$.50
ADDITIONS TO THE GENERAL FEE
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Unfts �$50 Per Unit
Each Additlonal UnR � S25
Lighting Retrofit � $25 per Fixture
Center Pivot Irrigation Boom � $40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites �$5 _ �
Separate Bonding Inspection � $20
Special tnspection � $30 per Hour
Special Inspection � $,31 per Mile
THIS INSTALLATION MAY BE i
i - 7 7 ? �- �7 �8S°
Outdoor Li htin Siandard f� $1
TraHic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA (� $20
Transfortner / Power Su for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$8C
Additional Inspectbn Trips � $20
Investiaative Fee
(minimum total fee is $20)
Foa iruvecTOn use arar
�d�— 3_ cz�.a���,l.l rcty�t�r-�rts
Y` �t��c 4 {1 L�k !r ^, i"'
I herebvi cerfiN that i insoected the electrical installation described herein on the d
18
Z2 ��3 t
Fort o�e use ow�r
I��Ill�llllllflllllll�4l�lllllllif11111111111fi1111 /;Q� .� �
� 1 2 7 B 7 3 O 5�E �*`� " � '
Request Date: Rough-in Inspection Required? es ❑ No Inspection O[her Than Rough-In: ❑ Ready Now ill Call
r
�� You must call the inspec[or when readyl Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe electrical work at:
Ctl-VWUTA-l'J //l/GUW BOAflO VF ELEGiRiGfTY GOPY NVSTfiUGT10N5 ON HAGK UF 7ELLOW GOP7