P - 79827E ' REQUEST FOR ELECTRICAL INSPECTION
1 2 6 6 7 0 8 �� Minnesota Board of Electricity
� � � 3 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� �A
� � (651) 642-OS00 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us �1
Identify the work covered by this request: �
❑ NEW ❑ REMODEL ❑ ADDITION REPAIR
GENERAL FE S
SERVICES / POWER SUPPLIES
0 to 400 Am ere �$25
401 to 800 Am re �$50
Above S00 Am re � $75
CIRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus �$.50
12 Units �
Outdoor Li htin Stand�rd � $1 '
Traftic 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 Si ns / Outline Li htin (� $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, Ail
Circuits and Two Inspection Trips Each Dwellin Unit �$8C
Additional ins ection Tri s�$20
Investi ative Fee
Reinsoection Fee � �20
total fee is
Center Pivot Irri tion Boom � - •
Manufactured Home Pafit Lots (�4 $25 I f�reby certily ihat I inspected the electrical installatbn described herein an the dates �:
Recreational Vehicle Park Sites �$5 R01GH1N
S rate Bondin Ins 'on � $20
S'al Ins ion �$30 r Hour '�"01
S ial In bn �$.31 r Mile
THIS INSTAL�ATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITH
FOR OFFICE USE ONLY
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3E 1 2 6 6 7 O S 5 iE /�Ci �`�
iest Date: Raigh-in Inspeclion Required? ❑ Yes No Inspection Other Than Rough-In: R�
You must call the inspector when ready! Date Ready:
` �— o'
18 MONTHS
o�GL/' �`'�
I ce ify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at