P - 78515REQUEST FOR ELECTRICAL INSPECTION
1 3 4 7 4 O 5 Minnesota Board of Electricity �
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
(651) 642-0800 TfY/MRS 1-800-627-3529
www.electricity.state.mn.us
Identity the work covered by this request: �� /� �� r �
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❑ NEW EMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard C� $1
S RVICES / POWER SUPPLIES TraNic Si nal Standard �$5
0 to 400 Am re �$25 "' Su lemental Fee �$20
401 to 8W Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transiormer / Power Su I for Si ns / Outline Li Min
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 . Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two InspecGon Trips Each Dwellin Unit �$BO
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins 'on Tri �$20
Each S em Device or ratus �$.50 Investl tive Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee �$20
MULTIFAMILY DWELLINGS PER UNI �v�w� rcc
3 to 12 U�its �$50 Per Unit (minimum total fee is $20) �S
Each Additional Unit � $25 �"'"�LTO" "� °NLV
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fixlure
Center Pivot Irri tion Boom � a40
Manufactured Home Paiic Lots �$25! 1 herebvi certiN that I inspected Me elecirical installa6on described herein on the dates stated:
Recreational
r�spection � $21
� $30 oer Hour
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTNS
FOR OFFlCE USE ONLY <�/\I�-� �
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Requ te: Rough-in Inspecdon Required? ❑ Yes o Inspecllon Other Than Rough-In: ❑ Ready Now ill Call
You musi call the inspectw when readyl Date Ready:
I t I am the�,�ICENSED CONTRACTOA ❑ COMPANY ❑ OWNER and hereby request inspectiai of the eiectrical work at: