P - 77011REQUEST FOR ELECTRICAL INSPECTION
1 3 4 7 5 4 4 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 ' x ,*�
❑ NEW ❑ REMODEL ❑ ADDRION ❑ REPAIR � S� C��� � V` S I
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traific Sianal Standard �$5
401 to 800 Am re �$50 Transtortners u to 10 KVA �$10 (J/ u� � �''" "
Above 808 � E75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transiomier / Pewar for S' / Outline Li h6n �$5
0 to 200 Am re �$5 ONE 8 TWO FAMILY DYVELLINGS, EACH UNR
Above 200 Am re �$10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUfTS OF LESS THAN 50 VOLTS Additional In bn T' �$20
Each S stem Device or tus �$.50 InvesU tive Fee
ADDITIONS TO THE GENERAL FEES R' ' Fee �$20
MULTIFAMILY DWELUNGS PER UNI TOTAL FEE :b
3 to �2 units � E5o Per unit (minimum total fee is $20) � S
Each Additional Unft � $25 F011N�Ci0R "� °NL'
OTHER ADDITIONAL FEES
Li htin Rehofit �$25 er Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots �$25 1 hereby cerMy that I inspected Ihe ekctrical instalialion described herein on the dates slated:
Recrealional Vehicle Park Sit�es O$5 nou� w o��
arate Bondin Ins ion � $20
S ial I 'on �$30 r Hour Flr� i"S"E�Ti°" o"�TE
S'al In ' n�$.31 r Mile �l `� o5
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑.Yes jSJ No Inspection Other Than Rough-In: ❑ Ready Now dl Call
�' - � You must call the inspecta when readyl Date Ready:
I certi(y tliat I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecUon of the electrical work at:
Job Address (Street, Bo o Route No.) City I��� n Zp�e
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