P - 77412REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electriciry �
1� 3 4 7- 5 3 5 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 T'fY/MRS 1-800-627-3529
www.electricity.state.mn.us
Identity the work covered by this request:
❑NEW ❑REMODEL ❑ADDITION REPAIR � {� a C'� � � ����'�r !� °i���
GENERAL FEE Outdoor Li htin Standard �$1
SERVICES I POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Su emental Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above S00 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transfortner / Power Su I for Si ns / Outline Li htin �$5
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, AII
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional In ion Tri �$20
Each S stem Device or ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Unics �$5o Per Unit (minimum total fee is $20) �
Each Addi�onal Unit �$25 F«+ir�sr�croR use or+iv
OTHER ADDITIONAL FEES
Li htin Retroffi �$25 er Fixture
Center Pivot Irri ation Boom �$40
Manufactufed Home Park Lots �$25 I he certiy that I in the electrical installation described herein on the dates stated:
Recreational Vehide Park Sites �$5 P01�"'" DA7E
Se arate Bondi Ins ection �$20 �` �—�����_
S ial In ' n�$30 r Hour F'""�'�s"E�"°" w,�
S' I In ' n(� $.31 r Mile
TNIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFlCE USE ONLY
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R�e� at �\�` Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: Ready Now ❑ Will Call
SYou 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:
Job Address (Street, Box, or Route No.) City Zip Code
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BOAHU OF ELECTRICRY COPY
Master License Number
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