P - 76549REQUEST FOR ELECTRICAL INSPECTION
( � � � � � � � � � � Minnesota Board of Electricity �-.� �:
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �-`
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Li htin Standard @$1
SERVICES I POWER SUPPLIES Traffic S' nal Standard $5
0 to 400 Am re $25 Su lemental Fee $20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Am ere $75 Transfortners over 10 KVA $ 20
CI CUITS / FEEDERS Transformer / Power Su I for Si ns / Outline 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 Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS AddRional Ins ion Tri s $20
Each S stem Device or A aratus $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins tion Fee $20
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE
3 to �2 Units @$5o Per Unit (minimum total fee is $20) �S ��
EachAdditionalUnit@$25 3 T�isnaFaFOairuaecra�useor��r
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OTHER ADDITIONAL FEES
Lightifl RetfOfit $.25 pCf FiXtut@ I hereby certify that I inspected the electrical installation described herein on the dates stated:
Center Pivot Irtiga6on Boom $40 RWGHIN oA,�
Manufactured Home Park Lots $25
Recreational Vehicie Park Sites $5 F'""""��T��+ oA�
Se arate Bondin Ins ion $20 -' �-�-��--��--�r �l C�e
Special Ins ion $30 per Hour �%�oinflwoaaEO pA�
Special Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS ___ __
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Date: Rough-in Inspection Required? Yes ❑ No Inspection Other Than Rough-In: Ready Naw ❑ Will Call
You must rall the inspector when ready! Date Ready: �
I ceRify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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