P - 82476REQUEST FOR ELECTRICAL INSPECTION
1 � Zj7 g 2 g � e Minnesota Board of Electricity
o, � 1821 University Avenue Suite S-128, Saint Paui, Minnesota 55104
'" ��� � (651) 642-0800 lTY/MRS 1-800-627-3529 �
www.electricity.state.mn.us
IdentiTy the work covered by this request: �_...._._ •'
EW ❑ REMODEL ❑ ADDITION ❑ REPAIR �,�.�; � --- �
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES I POWER SUPPLIES TrafGc Si nal Standard �$5
f 0 to 400 Am ere �$25 , p, Su lementa! Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power S fa � ns / Outline Li htl �$5
0 to 200 Am ere C� $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATiON, REMOTE CONTROL, SIGNALING CircuiGs ar�d Two Inspection Trips Each DweAi Unit �$90
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20 a3o .�
Each S tem Device or A ratus �$.50 Investi ative Fee
ADOITIONS TO THE GENERAL FEES Reins ion Fee �$20
MUL7IFAMILY DWELLINGS PER UNI � TOTAL FEE S� f� �
3 to 12 Units �$50 Per Unit �• (minimum total fee is $20)
EaCh AddRiOnal Unit �$25 wn irsaECron use oruv
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fixture
Center Pivot Irri a6on Boom �$40
Manufadured Home Park Lots I he certity that I i me electrkal installation desaibed herein on the detes sta�d:
Recreational Vehicle Park Sites p01�"" DA7E
Se arate Bondin Ins ection �$20
Saecial Insnection � $30 oer Hour �"6PECf0N � �/I _ _ �"'�
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FOR OFFICE USE ONLY ��
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Request Date: Rough-in Inspection Required? es ❑ No Inspection Other Than Rough-In: ❑ Ready Now I Call
�l1 "'� (� � You must call the inspector when readyl Date Ready:
I certity that I am the�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Address (SVeet, Box, or Route NoJ City Zip Code
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Phone
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31 Contractor Company Name Contractor License Number Master License
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Address (CoMractor, Company or Owner Performing Installation)
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OA D OF ELECTRIClTY COPY INS7RUCfIWJS ON BACK OF YELLOW COPY