P - 80507REQUEST FOR ELECTRICAL INSPECTION
1 17 6 O 7 6 Minnesota Board of Electricity
� � _� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
���� (651) 642-OS00 TTY/MR -800-627-3529
•� www.electricitv a� �r :
Identity the wosk covered by this request: /
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am ere �$25
401 to 800 Am re �$50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am re �$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S tem Device or A ratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
OTHER ADDITIONAL
Lighting Retrofit � $25 per Fixture
Center Pivot IrrigaUOn Boom � $40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites � $5
Separate Bonding Inspection � $20
Special Inspection � $30 per Hour
Spedal Inspection � $.31 per Mile
/9 C � ✓
utdoor Li htin Standard � $1
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transfortners over 10 KVA (� $20
Transformer / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 500 Amperes, All
Circuits and Two Insoe�tion Trips Each Dwellinp Unit �$8�
Fee �
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I herebvi certifv that I inspeded the elechical ir�stallafbn
total fee is
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF R�T COMPLETED WITHIN 18 MONTHS�_
FOR OFFICE U8E ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: Ready Now Q Will Call
9'/ • � You must call the inspector when readyl Date Ready:
I ceR'rfy that i am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of fhe electricai work at
Job Address (Street, Box, or No.) City Zip Code
.5; S",S"%
Section Township Range Fire No. County
,Occupant � Pho�e
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Authorized
E8-00001 A-13
Number I Master License
d. NW I�',�/4���
f ner Performing Installation)
ipany or Owner P rforming Installatlon) Phone
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BOARD OF ELEC7RICITY GOPY
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MSTRUCTIONS ON BACK OF YELLOW COPY