P - 80117REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity —
�� 3 3 2���`t ��'�°P 1821 University Avenue Suite S-128, �aint Paul, Minnesota 55104
(651) 642-0800 'TTY/MRS 1-800 �29
www.electricity.state.mn.0 ��
Identity the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION O REPAIR '
GENERAL FEES Outd r Li tin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su plemental Fee �$2�
401 to 800 Am re f� $50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / OuGine Li hbn �$5
0 to 200 Am ere �$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTRQL, SIGNALING C+rcuits and Two lnspection Trips Each Dwelli Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each stem Device or A ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee f� $20
MULTIFAMILY DWELLINGS PEq UNI TOTAL FEE
3 to t2 Units �$5o Per Unit (minimum total fee is $
Each Additional Unit �$25 FOR �NSPE�T�p USE ONL�
OTHER ADDITIONAL FEES �_� � _c t
Li htln Retrofit �$25 r Fixture ���
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots �$25 V hereby cerliiy that I inspected the electrical instaNation deuxibed herein on the dat� staded:
Recreational Vehicle Park Sites �$5 P01f*'" °A�
Se rate Bondin In ion � S20
S ial Ins ion �$30 er hbur r"�'�°E`"°" j^ ���
cial In ' � $.31 Nkle
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF PIOT COMPLETED WITHIN 18 MONTHS
� FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection RequiredT ❑ Yes ❑ No Inspection Other Than Rough- Now � WHI Call
' j�' O You must call the inspector when readyl Date Ready:
I certify that I am the�ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecGon of the electrical work at