P - 78498REQUEST FOq�LECTRICAL INSPECTION
1 3 5 8 3 g 1 Minnesota'�d of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529 ����� -
www.electricity.state.mn.us
Identiry the work covered by this request: /,�� D 1�/Iq � D ���� ��(�., `
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❑ NEW ❑ REMODEL" ADDITION ❑ REPAIR ���
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traific Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transfortners u to 10 KVA �$10
Above 800 Amoere �$75 Tra�formers over 10 KVA �$20
CIRCUITS / FE
o �o zoo a
Above 200
ALARM, COMA
CIRCUITS, CIF
Each Svst�
�
JICATION, REMOTE CONTROL,
IITS OF LESS THAN 50 VOLTS
Device or Apparatus � $.50
DDITIONS TO THE GENERAL F
Each Additional Unit � $25
OTHER ADDITIOP
Liyhtlm� Retrofd � $25 per Fature
Center Pivot Irtigation Boom � $4C
Manufactured Home Park Lols � $
Recreational Veh�le Park SRes �
Separate Bonding Inspection � $21
Snecial Insoection � $30 oer Hour
� Transfortner / Power Supply for Signs I Outline Lighting �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspecdon Trips Each Dwellin Unft �$8(
pec
Additional Ins ection Tri s�$20
Investi ative Fee
Reinsoection Fee � $20
y that I inspected tlre elactrical installation
� � ��
total fee is
ein on Uie da�s s�ted:
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FOR OFFICE USE ONLY
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neques a[e: Rough-in Inspection Required7 �Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now VHill Call
� `` 0� You must call ttie inspec[or when readyl Date Ready:
I certify that 1 am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
tts�xnq-73 7n/2000 BOARD OF ELECTRICITV COPY INSTRUCTIONS ON BACK OF YELLOW COPY