P - 78506REQUEST FOR ELECTRICAL INSPECTION
���F 7 415 Minnesota Board of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 l?Y/MRS 1-800-627-3529 =
` www.electricity.state.mn.us
Identiiy the work covered by this request: �
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❑NEW ❑REMODEL ❑ADDITION REPAIR —
GENERAL F S Outdoor Li htin Standard (� $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re�$25 G Su lemental Fee �$20
401 to 800 Am re�$50 Transformers u to 10 KVA �$t0
Above 800 Am re�$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transfortner / 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 and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuiis and Two Inspection Trips Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional I ion Tri �$20
Each S tem Device or A aratus �$.50 Invest' ative Fee
ADDITIONS TO THE GENERAL FEES Reinsoection Fee �$20 _
3 to 12 Units (� $50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
LigMing Retrofit � $25 per Fixture
Center Pivot Imgation Boom � $40
Manufactured Home Park Lois � $25
Reaeational Vehi�e Park Sites � $5
Seoarate Bondina Insoection � $20
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FOR OFFICE USE ONLY
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est Date: Rough-in Inspection Required? ❑ Yes No
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totat fee is $20) �� "
described herein on the dates
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w � You must call the inspector when readyl Date Ready:
I ceitiTy that I am �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe electrical wo�C at
Job Addr (Street, Box, or Route No.) City Zip Code
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Section Township Range Fire No. Counry
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�r S�lier Addre
Electrical Contredor / Co ny�! C� ctor License Number Master License Number
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Mai' g Address Cont ctor Compan Owner Performi Insfallation) �
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BOARD OF ELECTRICITY COPY INSTRUCTIONS ON �ACK dF VELLOW