P - 82009— REQUEST FOR ELECTRICAL INSPECTION
1 eo �� ��� � Minnesota Board of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� k�� �.� (651) 642-0800 TTY/MRS 1-800-627-3529
www.edectricity.state.mn.us `'�'
Identify the work covered by this request: �. �� �
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❑ NEW � REMODEI ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Tratiic Si nal Standard �$5
0 to 400 Am re 8$25 Su lementaf Fee �$20
401 to 800 Am ere �$50 7ransformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer I Power S 1 far Si ns ! Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am e�$10 Includes the Service andlor Power Suppty up to 500 Amperes, All
AU1RM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dweliin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S stem Device or A atus �$.50 Investi tive Fee
ADDITIONS TO THE GENERAL FEES Reinsoection Fee �$20
lnit � $25
OTHER ADDITIONA� FEES
total fee is
I herebvi certilv that I insoected the eleclrical inslallation descn7�ed herein on tlre
S rate Bondin Ins ection �$20 •
S ial In 'on f� $30 er Hour °AiE
S' Ins ecfion �$.31 er Mile ^ G
THIS INSTALLATION MAY BE ORDERED DISCONNECTED 1 COMPLETED WITHIN 18 ONTHS
FOR OFFlCE USE ONLY
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I Request Date: I Rough-In Inspection Required? ❑ Yes $WO I Inspeclion Otl�er Than Rough-In: �tepdy Now 0 wll C6N �
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IYou must call the inspector when readyl Date Ready:
I cerbty that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of tl�e elechical work ar
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INSTRUCTIONS ON BACK OF YELLOW COPY