P - 77260REQUEST FOR ELECl �VSPECTION
1 3 4 7 4 4 6 --Minnesota Board of Electricity
� � �1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 �
www. electrici ty. state. mn. us
Identify the work covered by this request:
❑NEW REMODEL ❑ADDITION ❑REPAIR 1d�c- —
GENERAL FEES
SERVICES I POWER SUPPLIES
0 to 400 Am re �$25
401 to 800 Am re �$50
Above 800 Am re � $75
CIRCUITS / FEEDERS
0 to 200 Am re �$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each m Device or ratus �$.50
ADDITIONS TO THE GENEFAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additlonal Unit � $25
OTHER ADDITIONAL FEES
Li hti Retrofit �$25 r Fbcture
Cerner Pivot I' ation Boom �$40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites � $5
Se arate Bondin Ins ion �$20
Soecial Insoection � $30 cer Hour
�c� n
Outdoor Li i Standard � $1
Tra(fic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer I Power Su for S� ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Ins ection Trips Each Dwellin Unit �$8(
Additional Ins ection Tri s�$20
Investi ative Fee
ReinsoecGon Fce � $20
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total fee is $201'(fJ�.
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I hereb ceAily ihat I inspected the electrical instellation described herein on the dates st
POUGH IN DR71
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FlNAL INSPECiION WTI
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FOR OFFlCE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection O[her Than Rough-In: ❑ Ready Now ❑ Will Call
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('�� 2�� G� You must call tbe inspector when ready! Date Ready:
I certify that I am fhe ❑ LICENSED CONTRACTOR ❑ COMPANY �WNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) Cily Zip Code
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Section Township Range Fire No. County �
Occupant Phone
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I Mailing Address (Contredor, Company o Owner Performing Insk
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Authorized Signatu�B ntracror, C parJy.�o er Perfortning
BOARD OF ELECRiICfiY COPY
Phone 7 �e i� � � T.� "� e I
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INSTpUCiIONS ON BACK OF YELLOW COPY