P - 79635REQUEST FOR ELECTRICAL INSPECTION
1 2 4 4 O 2 9 mtl � Minnesota Board of Electricity
� � ��� 1821 Universily Avenue Suite S-128, Saint Paul, Minnesota 55104
�� � (651) 642-0800 TTY/MRS 1-800-627-3529
' www.electricitv.state.mn.us " '
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR • (//'
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lementai Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above S00 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS I FEEDERS Transformer I Power Su I for Si ns / Outline Li hfin �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two InspecGon Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ction Tri s�$20
Each stem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$50 Per Unit (minimum total fee is $2
EeCh Addlti0n21 Unit �$25 FOFi INSPECTOfl USE ONLV
OTHER ADDITIONAL FEES N�S�L-�'"�
L� htin Retrofd �$25 r Fixture
Cemer Pivot t' don Boom �$40 i°a
Manufactured Home Park Lots �$25 I herety ce � that I in ed the electrical installetbn described herein on ihe uates stffied:
Recreational Vehicle Park Sites �$5 fl01GN �' DA1E
Se rate Bondin Ins io� �$20
S ial Ins 'on � $30 er Fbur �tl°�"1BPE°f01 � � �
S ecial Ins ion �$.31 er Mile �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Request�: Rough-in Inspection Required? [] Yes ❑ No Inspection Ottier Than Rough-In: - eady Pfow � Nfifl Cali
D� You must call the inspectar when ready! Date Ready:
I cerlify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elscUicai work at
Job Address (Street, or Route No.) C Zip Cotle
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Township
Au[horized
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Conhactor License
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BOAND OP ELECTRICRY COPY INSTpUCT10N3 ON BACK OF YELLOW COPY