P - 78328REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity ��`"�.
1� 3 4 7- 3 8 3 182� University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 -
� - www.electricity.state.mn.us
IdeMity the work covered by this request: � T
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❑NEW �REMODEL ❑ADDITION ❑REPAIR _;�A/YJ " �-r
0 to 400 Am re �$25 B U �G� ' Su lemental Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transfortners over 10 KVA (� $20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am re (� $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re�$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspectbn Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri �$20
Each S tem Device or ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fce �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE (
3 to t2 Un�s �$5o Per Unit (minimum total fee is $20) •.Y�
Each Additional Unit �$25 FOH INSPECTOfl USE ONLY
OTHER ADDITIONAL FEES
U htin Retroftl �$.25 r Fixture
CeMer Pivot I' ation Boom �$40
Manufactured Home Park Lots �$25 I hereby certily ihal I inspected the electrical installati�on described herein on the dates stated:
Recreatlonal Vehide Park Sites �$5 '�" �" oa,�
te Bondin Ins ion � $20
S �al In 'on �$30 r Hour FTM^� "��"�" wre
S'al Ins ion �$.31 r Mile '�—'°�°`°-�p ��
_ THIS INSTALLATION MAY BE ORDERED DISCONNECT NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONIY
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Request D e: Rough-in Inspection Required? ❑ Yes No Inspec[ion Other Than Rough-In: ❑ Ready No Will Call
'� ��O You must call the inspector when readyl Date Ready:
I certiiy that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY�OWNER and hereby request inspection of the electrical work at: