P - 77730REQUEST FOR ELECTRICAL INSPECTION
1/�7 Minnesota Board of Electricity ' �
1��`t 1- 3 4 7 �821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
, (651) 642-0800 TTY/MRS 1-800-627-3529 - -
www. electriciry. state. mn. us
Identity the work covered by this request:
❑ NEW ❑ REMODEL ADDITION ❑ REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am re �$25 �
401 to 800 Am re�$50
Above 800 Am re � $75
CIRCUITS / FEEDERS
0 ro 200 Amcere � $5
Outdoor Li htin Standard �$t s
Traffic Si nal Standard � $5
Su lemental Fee � $20 �
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li hUn �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, AII
Circuits and Two Inspection Trips Each Dweliin Unit �$SO
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addftional Ins ion Tri s�$20
Each S stem Device or ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee �$20
MULTIFAMILY DWEILINGS PER UNI
3 to 12 Units �$50 Per Unit (mini
Each Additional Unit � $25 w" "a"E�`0" "� °NLY
OTHER ADDITIONAL FEES
Li htln Retrofit �$25 r Fixture
Center Pivot I' ation Boom �$40
Manufactured Home Park Lots �$25 I hereby cedify that I ins ted the eiec�rical instauz
Recreational Vehicle Park Sites � 101GN1N �
rete Bondin In 'on � $20
S ial Ins 'on �$30 r Hour F'""` k"S°"'"°"
' I I ' � $.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NO��PLETE
FOR OFFlCE USE ONLY �
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* 1 3 4 7 3 4 7 5� ��
R��st Datg:� �� Rough-in Inspection Required? Yes No Inspection Other Than Rough-
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You must call the inspector when ready! Date Ready:
total fee is $20) � �i.5-I
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on the�dates stated:
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I certity that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY OWNER and hereby request inspection of the electrical work at:
Job��Str�@t, Box, or Route �� L,"L -� tty �+ � � ZiP `�� �
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Section Townshi � Range Fire No. oun
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Po r Su I' r� � Address � t�` '^ � ��--�^
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Electrical ntracJq�/ Company Name � C ntrador License Number Master License Number
� Mailing Address�(ConVador, �panY or Owner
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BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY