P - 79786REQUEST FOR ELECTRICAL INSPECTION
�g Minnesota Board of Electricity
1 v� 5 4, � 4 H g '� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
������ (651) 642-0800 TTY/MRS 1-800-627-3529 �
� www.electricity.state.mn.us �, � 33 �
Identify the work covered by this request: �� `0.V g p.w
❑NEW '�I'�EMODEL ❑ADDITION �REPAIR IOSI � �'� ���5�
0 io 400 Ampere �$25 �Oa 1�
401 to 800 Ampere � $50
Above 800 Ampere � $75
�UITS / FEEDERS
0 to 200 Ampere � $5
Above 200 Ampere (� $10
RM, COMMUNICATION, REMOTE CONTROL,
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL f
.TIFAMILY DWELLINGS (PER UNI�
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Retrofrt � $25 per Fixtu
'ivot Irrigation Boom � $
lured Home Park Lots �
Outdoor Li htin Standard � $1
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer I Power Su I for S' ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$Sf
Additional Ins ection Tri s�$20
Investi a6ve Fee
Reins ion Fee � $20
� SO TOTAL PEI
�a' (minimum total fee is $20
Ofl INSPECTOF USE ONLV
���el� aS�¢il d u..� /��i /� e �—
herebv cerlAv that I insoected the electrical installalion described herein on the
S ial Ins 'on �$30 r Hour """'""`"'""' �
SDecial Inspection �$ 31 per Mile � " G- `� �`��� f Z�� �^
� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Olher Than Rough-In: ❑ Ready Now Will Call
�OC - 9- oa You must call the inspec[or when readyl Date Ready: / � ,3� �
I certity that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: