P - 77665REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity �Q � C7�3l� �
1� 3 4 7 � 1821 University Avenue Suite S-128, aint�aul, Minnesota 55�
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electrici ty. state. mn. us
Identity the work covered by this request: (]� � � � � � �� � �
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❑ NEW ❑ REMODEL ❑ ADDITION REPAI
GENERAL FEE Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Tra(fic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am re�$50 Transfortners u to 10 KVA �$10
Above 8(10 Am re �$75 Transiormers over 10 KVA �$20
CIRCUITS / fEEDERS Transtormer / Power Su for Si ns / Outline Li htin �$5
0 to 200 Am re �$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, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Tri Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ction Tri s�$20
Each S tem Device or A ratus �$.50 Investi tive Fee
ADDITIONS TO THE GENERAL FEES Reinsoection Fee �$20
.TIFAMILY DWELLINGS (PER UNI�
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Lighfing Retrofit � $.25 per Fixture
Center Pivot Irrigation Boom � $40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites � $5
Separate Bonding tnspection � $20
S ecial Ins 'on �$30 r Hour �'"��10"
Special Inspection � $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTE
FOR OFFICE USE ONLY
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total fee is
the eleclrical inshallation descdbed herein on ihe dates
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WITHIN 18 MONTHS
rtequest uat : ough-in Inspection Required? �] Yes pqJo Inspection Other Than Rough-In: �'Ready Now � Will Call I
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You must call the inspector when ready! � Date Ready: /
I certiiy that I am the LICENSED CANTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job A ( treet, No.) City Zip Code
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Section Towns ip Ranae Fire No. Countv� w
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Address (Co�tractor,
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ARD OF ELECTRICRY COPY INSTRUCTIONS ON BACK OF YELLOW COPY