P - 78516REQUEST FOR ELECTRICAL INSPECTION
1 3 4�7 3 8 1 0 Minnesota Board of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
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Identity the work c vered by tnis request:
❑ NEW EMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am ere �$25
401 to 800 Am re �$50
Above 800 Am re � $75
CIRCUITS / FEEDERS
0 to 200 Am re �$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SI�NALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each stem Device or A ratus �$.50 i
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
CeMer P'rvot Irrigation Boom � $4C
Manufactured Home Park Lots � $
Recreational Vehicle Park Sdes � '
Separate Bonding Inspection � $21
Special Inspection � $30 per Hour
Soecial Insoection � $.31 oer Mile
1
Traflic Si nal Standard �$5 y�
Su demental Fee � $20
Transfortners u to 10 KVA �$10
Trensfortners over 10 KVA � $20
Transformer / Power Su for Si ns / Oudine ' �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
CircuRs arni Two Ins ection Trips Each Dwellin Unit �$8(
AddRbnal Inspection Trips � $20
InvestiaatNe Fee
(minimum total fee is $20) �
FOfl INSPECTOH USE ONLV � �
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I herebv cenlv thaf I inspected fhe ek.�chical insfalla6on described herein on the dates
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Reque e: Rough-in Inspection Required? + es ❑ No Inspection Other Than Rough-In: .❑ Reedy Now ill Call
S(J You must call the inspector when ready! Date Ready: �
I cer6fy that am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) C , �P �
! 291 1�j ` h,�,v,r�,Q,z:� , �v� I ��N 2
Section Township Range Fire No. oun
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� Power Supplier
Installation)
Performing
EB-OOOOtA-13 7/1/2 � BOARD OF ELECTRICRY COFY
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INSTRUCTIOWS ON BACK OF YELLOW COPY