P - 77548REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity �' °�
�L � 3 4 7- 4 8 3 �82� University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 T'fY/MRS 1-800-627-3529
www. electrici ty. state. mn. us
IdeMiTy the work covered by this request:
❑NEW OREMODEL ❑ADDfTION ❑REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am re C�
401 to 800 Am re�$50
Above 800 Am re � $75
CIRCUITS / FEEDERS
0 to 200 Am re �$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S em Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEE
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
Li htirt Retrofrt �$25 er Fixture
CeMer Pivot Irri ation Boom �$40
Manufactured Home Park Lots � $
Recreational Vehicle Park Sites � ;
Se arate Bondin Ins ection �$2(
S ial Ins 'on �$30 r Hour
S'al Ins ' n(� $.31 r Mile
_ THIS INSTALLATION MA
Outdoor Li htln Standard � $1
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su d for Si ns / Outline Li Min �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and�or Power Suppty up to 500 Amperes, All
Circufts and Two Inspection Tri s Each Dwellin Unit �$8(
Additional Ins ection Tri s�$20
Investi tive Fee
Reinsuection Fee � S20 <Tw�.�:
(minimum total fee is $20) l� �
Y
I inspected tlie electrical installation described herein on tlie dates stated:
DFTE
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' � ��J �
OT COMPLETED WITHIN 18 MONTHS
FOR OPFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rou h-In:
g ❑ Ready Now ❑ Will Call
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: