P - 77632REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity �-
1� 3 4 7- 4 9 6 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 =
www.electri�%te.mn.us ��' . Q�O� �
Identify the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION �EPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am re (� $25
401 to 800 Am ere �$50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am re �$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus �$.50
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDRIONAL FEES
Lighting Retrofit (� $25 per Fixture
Center Pivot Irrigation Boom � $40
Manufactured Home Park Lots (� $25
Recreational Vehide Park Sites � $5
Separate Bonding Inspection � $20
Special Inspection � $30 per Hour
�al Inspection � $.31 per Mile
THIS INSTALLATION MAY BE (
� l"J �.L
Outdoor Li htin Standard � $
Tra(fic Si nal Standard �$5 a,
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su for Si ns / Outline Li hti �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$8(
Additional Ins ection Tri s�$20
Investigative Fee
Reinsoection Fee � $20
INSPECTOR USE ONLY
�rebvi ceRifv that I insoected the eleclricel installation
total fee is
on the dates stated: I
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IF NOT COMPLETED WITHIN i6 MONTHS
/�2 —
FOR OFFlCE USE ONLY
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Requ t Date: Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now ill Call
jQ �� You must call the inspector when ready! Date Ready:
I certity that I am the �,LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
E&OOOOtA-13 7/1/2000 BOARD OF ELECTRICRY COPY INSTRUC71pNS ON BACK Of YELLOW COPY