P - 79723� ,,,r
REQUEST FOR ELECTRICAL INSPECTION
1 � � � � � � Minnesota Board of Electricity -�
� � 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
� °„ �e (651) 642-OS00 TTY/MRS 1-500-627-3529
www. edect rici ty. state. mn. us
Identify the work covered by this request: � /� J�
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❑ NEW ❑ REMODEL ❑ADDITION ❑ REPAIR �
GENERAL FEES Qutdoor li h Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA (� $20
RCUITS ! FEEDERS Transformer I Power Su for Si s I Outline Li hti �$5
0 to 200 Am ere Q$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling UnR �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ction Tri s�$20
Each S tem Device or A ratus c� $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee �$20
total fee is
Each Additional Unit � $25 '"'""''"" "" �""
OTHER ADDIiIONAL FEES
Li htin Retrofit �$25 er Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots (� $25 I h " ce ' that I inspected the electrical installation describedherein on the dates stated:
Recreational Vehicle Park Sites �$5 "�"" DA1�
Se arate Bondin Ins ection �$20
S ecial Ins ection �$30 r Hour Fl114LN�070N DA1f
' I I io� �$.31 r Mile ���3 '�
____ THIS IN$TALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOW OFFICE USE ONLY
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Request Date: Rough-in Inspeclion Required? ❑ Yes ❑ No Inspection Other Than Rough-In: Ready Now � Will. Call
����� �� You must call the inspector when ready! Date Ready:
I certiTy that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of tlie electrical vrork at:
Job Address (Sheet, x, o�te No.) Zip Code
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Section Township Range Fire No. County
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Occupant Phone
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BOAHD OF ELECiA1CIlY COPY INSTRUCT10N8 ON BACK OF YELLOW COPV