P - 79583REQUEST FOR ELECTRICAL INSPECTION
1 � � � � � � � �� Minnesota Board of Electricity ��
� � ���; 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
,. � "° (651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. state. mn. us
IdentiTy the work covered by this request: �,�,�Op�,(��_
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EW ❑ REMODEL ❑ ADDITION CJ REPAIR �
GENERAL FEES Outdoor Li htin Standar $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 70 KVA C� $20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 io 200 Am ere (� $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 and Two Inspection Trips Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20
Each S stem Device or A aretus �$.50 Investi ative Fee
ADDITIONS TO THE GENERALFEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE
3 to 12 Units � g5o Per Unit (minimum total fee is $20) (,.�
Each Additional Unit �$25 � ��PE�TOp U ONLY
OTHEFi ADDITIONAL FEES
Li htin Retrofit �$25 r Fixture �
Center Pivot I' aUon Boom �$40
ManufSCtured Home Pa�k Lots �$25 I hereb certity that I inspected the electrical installadon descnbed herein on �he dates siated:
Racraatinnal Vahirla Park Citu¢ 0 4S . �'�+�+ o�7E
Hour
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FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-In: �14eady Now ❑�11 Call
— a ��. You must call the inspector when readyl Date Ready:
I certi(y that I am the `�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Address (Street, Box, or Route No.) City 7rp Code
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Section Township Range Fire No. Cou
I Power Supplier
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Address
Name Contractor License Number Mast
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npany or Owner Perfortning Installation)
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BOARD OF ELECTRICRY COPY INSTRUC710N8 ON BACK OF YELLOW COPY