P - 79821i� REQUEST FOR ELECTRICAL INSPECTION
y � O� ��� ��� Minnesota Board of Electriciry —
�� � �� 1821 University Avenue Suite S-t28, Saint P ul, Minnesota 55104
�����`� (651) 642-0800 TTY/MRS 1-800-627-352� � ��
www.electricity.state.mn.us
Identify the work covered by this request: ���✓ ����
❑ NEW REMODEL ❑ ADDITION ❑ REPAIR �� b .�� D lX �/ l
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 Transformers u to 10 KVA �$10
Above S00 Am re �$75 Transformers over 10 KVA �$20
RCUITS / FEEDERS Transformer I Power Su for Si ns I Outline Li htin �$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 Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF tESS THAN 50 VOL7S Additional Ins ion 7ri s�$20
Each S stem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinscection Fee �$20
iirnmi�T UWCLLIIVUJ rcn unn
3 to 12 Unns �$50 Per Unit (minimum total fee is $20)
Each Additiona! UnR � $25 F0"'"�CTO" "� °NLY
Center Pivot Irri ation Boom �$40
Ma�uf2Ctufed Home P2tk LOis �$25 I hereby cerMy that I inspected the electrical instaliation described herein on the dates stated:
Recreational Vehicle Park Sites �$5 HOUGH IN onre
Se rate Bondin In ion �$20
S ecial Ins ection �$30 r Hour "N"` �""10N °ATE
S ial Ins ection �$.31 er Mile Y L Y—°' 3
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFlCE USE ONLY
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Requ Date: Rough-in Inspeclion Required? ❑ Yes No Inspection Olher Than Rough-In: ❑ Ready Now Wili Call
�� �� � You must call the inspector when readyl Date Ready: �
I certify that I am the [�f LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at