P - 79873� REQUEST FOR ELECTRICAL INSPECTION
-� � J� 2 41 � Minnesota Board of Electricity
i � °� 1821 University Avenue Suite S-128, Saint P I, Minnesota 55104
�F� (651) 642-0800 TTY/MRS 1-800-827-3529
www.electricity.state.mn.us � �� �
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Identify the work covered 6y this request:
❑ NEW EMODEL ❑ADDITION ❑ REPAIR P� � VLLC,V U 7 C S 1 � ` � �' ! �' � �
GENERAL FEES Outdoor Li htin Standard �$1
0 to 400 Am re �$25
401 to 800 Ampere � $50
Above 800 Ampere (� $75
:UITS / FEEDERS
0 to 200 Ampere � $5
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTROL, SIGNALING
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus �$.50
Lighting Retro�t � $25 per Fixture
Center Pivot Irrigatan Boom � $4(
Manufactured Home Park Lots � 9
Recrea6onal Vehicle Park Sites �
Separate Bonding Inspec6on � $2�
Special Inspecbon � $30 per Hour
Soecial Insoectan (� $.31 cer Mile
Traffic Si nal Standard � $5
Su Iemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li htin �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Inciudes the Service andlor Power Supply up to 500 Amperes, All
CircuiGs and Two Inspection Trips Each Dwellin Unit �$8f
Additional Ins ection Tri s�$20
Investi ative Fee
Reinsoection Fee � $20
thatlinsoected the electrical
�m total fee is $2Q
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITFIIN 18 MONT1i5
FOfl OFFlCE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now Will Cail
�,�/D� You must call the inspec[or when ready! Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work aC
Job Address (Street, Box, or Route No.) � City �P ��
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Occupant
Power Supplier
Electrical
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