P - 82487RECIUEST FOR ELECTRICAL INSPECTION
�° Minnesota Board of Electricity Y
��� 3��� 8� ���� 1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104
n� � (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us
IdentiTy the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR W V l�• ���. �
GENERAL FEES or Li htin Standard C� $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Ampere �$25 Su lemental Fee �$20
40i fo 800 Am ere �$50 Transformers u to 10 KVA (� $10
Above 800 Amcere �$75 _ Transfortners over 10 KVA �$20
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTROL,
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus �$.50
3 to 12 Uniis �$50 Per Unit
Each Additional Unit f� $25
OTHER ADDITIONAL FEES
Lighting Retrofit � $25 per Flxture
Center Pivot Irriaation Boom � $40
Inspection � $2f
� $30 per Hour
� 5.31 oer Mile
Transformer / Power Su I tor Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 500 Amperes, All
Cirouits and Two Inspection Trips Each Dwelling Unit �$8t
Additional Inspection Trips � $20
Investigative Fee
Reinsoection Fee � $20
total fee is
I insoected the elecfricel irstallation described herein an the dates
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FOR OFFICE USE ONLY
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Requ Date: Rough-in Inspection Required? ❑ Yes Inspec[ion OTher Than R gh-In: Now ❑ Will Cel�
You must call the inspector when readyl Date Ready: �
I certi(y that I am the ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request mspection of the electrical work at:
Job Address SVeet, x, or Route No.) � Ciry �� z� e ��
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Section Township Range Fire No. County
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Power Supplier • • Address
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Electrioal racror / Company Neme ., Contractor License
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Mailing Addre (Contra or, Company r Owner Perfortning Installation)
02l c� �, '� r r
AuUiorized S' nature (Contra paay or Owner Perf g Installation)
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E&00001A-13 7/t/'L000 BOAHD OF ELECTRICITY COPY
License Number
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INSTFIUCTIONB ON BACK OF YELLOW COPY