P - 78570REQUEST FOR ELECTRICAL INSPECTION
1 2 41 7 9 g Minnesota Board of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
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�, (651) 642-0800 TTY/MRS 1-800-627-3529
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www.electricity.state.mn.us
Identify the work overed by this request: ���� � � /
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❑ NEW REMODEL ❑ ADDITION ❑ REPAIR �t� V
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su for Si ns / Outline Li htin �$5
0 to 200 Am re f� $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 A re �$10 Includes the Service and�or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING �rcuits and Two Inspectio Each Dwellin Unft �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Rional Ins ection ri �$20
Each S stem Device or atus �$.50 Investi tive Fee
ADDITIONS TO THE GENERAL FEES Reins ction Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$5o Per Unit (minimum total fee is $20) �
Each A�ftional Unit (� $25 � INSPECTOIi USE ONLV
OTHER ADDITIONAL FEES
Liahtina Retrofit � $25 oer Focture
Manufac�ured Home Park Lots �$25 I hereby certily that I inspecled the electrical installadon desaibed herein on the � stated:
Recreational Vehicle Park Sites �$5 101�' "' 2 ��
Se rate Bondin In bn �$20 �"�— J�2 ��
S ecial Ins ection �$30 r Hour F'""""Sr�c.'°" � �� �,
S ial In ection �$.31 r Mile �_ ���G
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED W(T?NN 18 MONTHS
_i FOR OFFICE USE ONLY
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Request Date: Rough-io Inspectlon Required? es ❑ No Inspection Other Than Rough-In: ❑ Ready Now ill Call
� �3 You must call the inspector when readyl Date Ready:
1 certify that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspectia� of the electrical work at