P - 82480REQUEST FOR ELECTRICAL INSPECTION
° Minnesota Board of Electriciry �" `
� r O 2 7� 9 3 7 a 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�vne,P;� (651) 642-0800 TTY/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 / POWER SUPPLIES Traific Si nal Standard �$5
1 0 to 400 Am ere (� $25 u. Su lemental Fee �$20
401 to 800 Am re (� $50 Transformers u to 10 KVA �$10
Above 800 Am re @$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transfortner / Power Su I for Si ns / OuUine Li htin �$5
0 to 200 Am ere �$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 LESS THAN 50 VOLTS Addftional In ion Tri s�$20
Each Svstem Device or Aooaratus �$.50 Investigative Fee
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Lighting Retrofit � $25 per Fixture
Center Pivot Irrigation Boom � $40
Manufactured Home Park Lots � $25
Recreatbnal Vehicle Park Sites � $5
Separate Bonding Inspection � $20
USE ONLV
total fee is $20) �a°• S� I
described herein
S ial In wn �$30 er Hour �
Special Inspection � $.31 per Mile �� � `—"�I
__JHLSJN$I9LLATLQI�LMAY BE ORDERED aSCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY ` r
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Request Date: Rough-in Inspection Required? es ❑ No Inspection Other Than Rough-In: ❑ Ready Now Sd'Ol'ill Call
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Q—� —(�i You must call the inspector when readyl Date Ready:
I cerMy that I am the �CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecUical wak at
Job Address (Street, Box, or Route No.) City Z�p Code
tao o •
Section TownshiD �enge Fire No. Coun
Power Supplier 1
Electrical CoMractor / Company
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Phone
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Address
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� Contrac[or License Number Master Lic:ense
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or Owner Pertorming Installation)
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