P - 78256REQUEST FOR ELECTRICAL INSPECTION
1— 4, � 8— 8 2 6 � Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OB00 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW MODEL ❑ ADDITION ❑ REPAIR Desaibe -using the back of fhe white copy 'rf necessary - the work covered by this request:
GENERAL FEES dC Outdoor Li htin Standard $1
SERVICES I POWER SUPPLIES + Traffic S' nal Standard $5
0 to 400 Am re Su mental Fee $20
401 to 800 Am $50 Transformers u to 10 KVA S10
Above 800 Am re y75 oc% Transfomiers over 10 KVA $ 20
CIRCUITS I FEEDERS Transformer I Powei Su I for Si ns / OuUine Li h6n $5
0 to 200 Am re ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am $10 Includes ihe Service �dla Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit � 380
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins tion Tri E20
Each Svstem Device or Apoaratus � 5.50 Investiaative Fee
3 to 12 Units @$50 Per Unit
Exh Additional Unit C� $25
OTHER ADDITIONAL FEES
LighGng Retrofit @ E.25 per Fixture
Center Pivot Irria�on Boom � S40
( TOTAL FE; I ��
minimum total fee is $20
TMS AREA Fqt INSPECiOR USE ONLY
I hereby cextity that I inspec0ed the electrical installa6on described herein on the dMes sta0ed:
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R uest Date: Rough-in Inspection Required'? ❑ Yes No I�pedion Other Than Rough-In: Ready Now � Will Call
�'i �� You must wll the inspecta when ready! Date Ready. .
I certify tl�at I am the �LICENSED CONTRACTOR 0 COMPANY ❑ OWNER and hereby request inspection of the electrical work at: