P - 78329REQUEST FOR ELECTRICAL INSPECTION
� J� � ��� Minnesota Board of Electricity �`�i
� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
-- (651) 642-0800 T'fY/MRS 1-800-627-3529 -
www. electrici ry. state. mn. us
Identity the work covered by this request: ,�
❑ NEW REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li hti Standard �$1
SERVICES / POWER SUPPLIES Traffic S' nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am re �$50 � Transformers u to 10 KVA �$10
Above 800 Am re C� $75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Amoere � e. ONE & TWO FAMILY DWELLINGS EACH UNIT
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem De�rice or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units (� $50 Per Unit
Each Additional Unit � $25
Lighting Retrofd � $25 per Fixture
Center Pivot Irrigation Boom � $4(
Manufactured Home Park Lots � $
Recreational Vehicle Park Sites �
Separate Bonding Inspection � $21
S ial I 'on �$30 r Hour
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unft �$80
Additional Inspection Trips (� $20
Inves6aative Fee
I herebvi certifv that I insoected the electrical installation
TOTAL FEE
total fee is $20) �.
stated:
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
POR OFFICE USE ONLY , �� .� ��
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Request Date: Rough-in Inspection Required? ❑ Yes ns ection O[her Than Rou h-In:
p g ❑ Ready Now ❑ Will Call
��O�" You must call the inspector when readyl Date Ready: �- ,2,� Gs
I certi(y that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: