P - 77405REG�UEST FOR ELECTRICAL INSPECTIO
Minnesota Board of Electricity ��-�/)/')�- vp�(� �g �
1-_3 4 7- 5 3 0 1821 University Avenue Suite S-128, Saint �aul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 - _
www.electricity.state.mn.us
Identify the work covered by this request:
❑NEW ❑REMODEL ❑ADDITION REPAIR �-G, � iwi�`� ���T 0n � .
GENERAL FE S Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES raffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fce (� $20
401 to S00 Am re �$50 Transfotmers u to 10 KVA �$10
Above 800 Am re �$75 Transfortners overl0 KVA �$20 I
CIRCUITS / FEEDERS Transfortner / Power Su pl for Si ns / Outline Li hti �$5
0 to 200 Am re �$5 ONE 8 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 Tri s Each Dwellin Unit �$80
CIRCUITS, CIRCURS OF LESS THAN 50 VOLTS Additional Ins 'on Tri s�$20
Each S em Device or A aratus �$.50 Invesii tive Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE S
3 to t2 units �$50 Per Unit (minimum total fee is $20) %
Each Additional Unit (�➢ $25 � ��T�+ � a+��
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fixture
Center Pivot I' atlon Boom �$40
Manufactured Home Park Lots �$25 � hereby certity that I inspected the electrical installation described herein on the dates stated:
Recreati�onal Vehide Park Sites �$5 fl01�"'" op�
Se rate Bondi I ion �$20
S ial In �on �$30 r Hour �"����" oa,�
S 'al Ins 'on � $.31 r Mile , ' �— �''� q
_ THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTliS
FOR OFFlCE USE ONIY
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Request Date: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: Ready Now ❑ Will Call
�Q� You must call the inspector when ready! Date Ready:
I certify 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 Zip Code
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BOARD OF ELECTRICRV COPY INSTAUC710N3 ON BACK OF YELLOW COPY