P - 80164- REQUEST FOR ELECTRICAL INSPECTION
`� � � � � � � � � �. a Minnesota Board of Electriciry
� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�� � (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us
Identity the work covered by this request: �� �1��„� � W.V� �
�IEW ❑ REMODEL ❑ ADDITION ❑ REPAIR n , � �
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES I POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee 8$20
407 to 800 Am re�$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transfortner / Power Su for Si ns I Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, FiEMOTE CONTROL, SIGNALING Circuits and Two Inspeclion Tri s Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri �$20
Each S tem Device or A ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee �$20
MULTIFAMILY OWELLINGS PER UNI � � ,� TOTAL FEE
3 to 72 Units �$50 Per Unit ���;J�n.0 � (minimum total fee is $20) 3�•�
EaCh Additi0nal U�it �$25 FOF INSPECTOfl lISE ONLV '
OTHER ADDITIONAL FEES
I herebv ceRM that 1 insoected the eleclrical installation descnbed herein ai
Recreational Vehicle Park Sites �
� J Special Inspection �$.31 per Mile � � ��' �--ti"�—e�e `�<' v�{..
THlS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? � Yes �q10 !n
^ /„ spection Other Thart Aough-In: eady Now [] �II Cali
� w d � You must cail the inspector when ready! Date Ready: �
I certify that I am the�.ICENSED CONTRACTOR ❑ COMPqMY
❑ OWNER and hereby request inspection oi ihe etectricai work at.
Job Address (Sheet, Box, or Route NoJ C�,
�'yc� ZP Code
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I OccuPant
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Address
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