P - 76391r� REQUEST FOR ELECTRICAL INSPECTION �
2�' o J�� 4 b 6� Minnesota Board of Electricity �-
1821 University Avenue Suite S- int Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-8 7- 529 www.electricity.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Li htin Standard $t
SERVICES I POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Am re $25 Su plemental Fee @$20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Am re $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer I Power Su I for Si ns I Outline Li htin $5
Z 0 to 200 Am re $5 ONE & 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 Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addftional Ins ion Tri s $20
Each S stem Device or Ap aratus $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee $20
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE
3 to 12 Units C� $50 Per Unit (minimum total fee is $20) ��C �
ADDITIONAL FEES
Center Pivot Im ation Boom $40
ManuFactured Home Park Lots $25
Recreational Vehicle Park Sites $5
Se arate Bondin Ins on $20
Special ins ection $30 per Hour
Special Ins 'on $.31 per Mile
_ THIS INSTALLATION MAY BE ORDERE�
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I hereby certiy that I inspeded the electrical installafion described herein on the dates staled:
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CTED_IF NOT COMPLETED WITHIN 12 MONTHS ________�
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��� Rough-in Inspection Required7 ❑Yes �]Na InspecXion Other Than Rough-In: Ready Now ❑Will Call
/ r 7 �� / You must call ihe inspector when ready! Date Ready:
I certify that I am the (�j LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Address City
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Contractor / Company Name
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