P - 78854REQUEST FOR ELECTRICAL INSPECTION
`� ��� 0�� 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 wvered by this reques[ /„ �_ �� �e� �� L„j �� i
LGec.�
❑ NEW �`I REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li hti Standard �$7
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re�$25 D 6 Su IemeMal 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 Transformer / Power Su for S' ns / Oulline ' htin � S5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNR
Above 2� Am re�$10 Includes the Service andlor Power Suppty up to 500 Amperes, NI
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Ins ction Trips Each Dwelli Unit �$�
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ' n Tri �$20
Each S em Device or A aratus �$.50 Inves6 tive Fee
ADDITIONS TO THE GENERAL FEES R��P�� F� ��
Each Additional Unit � $25 """`"'"" °" ""'
OTHER ADDITIONAL FEES
' hti Retrofit � $25 FoRure
Center Pivot Irri ation Boom �$40
Manufactuted Home Park Lots � E25 I he ce ' thet I' the eledrical inst�laUOn desaibed herein ai 1he deOes stffied:
Recreational Vehide Park Sites � $5 "0101 �' ��
Se arate Bornii In 'on � $20
S�al Ins 'on �$30 r Hour ""` v1�"d1 / ��
S ial Ins eclion �$.31 r Mile �Q `� 2^�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONT^ HS �
FOR OFFICE U8E ONLY
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Req � t . Rough-M Inspectlon Required? ❑ Yes - o Inspecdon Other Than Rou Mln: ❑ Ready Now tl Call �
6 You must rall the inspector when ready! Date Ready: ��
I certify that I am ihe�j LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at