P - 78441REQUEST FOR ELECTRICAL INSPECTION
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1� 3 4 7- 3 2 4 Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
• (651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. state. mn. us
Identify the work covered by this request: �
❑ NEW ❑ REMODEL �DDITION ❑ REPAIR � �L �� �
GENERAL FEES Outdoor Li htin Standard �$t
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere � Su lemental Fee �$20
401 to 800 Am $50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers rner 10 KVA �$20
IRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am ere � 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 Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addftional Ins 'on Tri (� $20
Each S em Device or A aretus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$50 Per Unit (minimum total fee is $20
Each Additional Unit � $25 '�" �T�" � �� ._ / �
OTHER ADDITIONAL FEES eT7�
� htin Retrofd � $25 r Fixlure
Center Pivot Irri tion Boom �$40
Manufactured Home Park Lots � I hereby cerMy that I inspected e eledric� insqlladon described herein on the dates s�ted:
Recreational Vehi�e Park Sites "01GH �' �"�
Se rate Bondin Ins 'on � 1----`, �,"�%��
S ial Ins 'on �$30 er Hour �"�"01 � �T�
S ecial Ins ecUon �$.31 r Mile �l� "��3 �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR O�ICE U5E ONLY
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Request Dat Rough-in Inspeclion Required? Yes ❑ No Inspection Olher Than RougMln: ❑ Ready Now wll Call
�`� lJ V� You must call the inspector when readyl Date Ready:
I certiiy that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY �OWNER and hereby request inspection of the electrical work at: