P - 79540. RE(�UEST FOR ELECTRICAL INSPECTION
1 I�� ��� Minnesota Board of Electricity —
� 1 � �� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� 0 (651) 642-0800 TTY/MRS 1-800-627-3 29
www.electricity.state.mn.us �' "�'
IdentiTy the work covered by this request: ,
❑NEW ❑REMODEL CJADDITION �HEPAIR
GENERAL FEES Outdoor Lighting Standard �$1
0 to 400 Am ere �$25
401 to S00 Ampere � $50
Above S00 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 20U Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
Retrofd � $.25 per Fixture
'ivot Irriaation Boom � $4C
� �0 DEf �OUf
Traffic Si nal Sta�dard @ $5 \J
Su demental Fee � $20
Transformers u to 10 KVA �$10 _
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li htln �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Inciudes the SeNice anNor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$8C
Additional Insoection Trios � $20
Fee �
F011 INSPECTOIi
total fee is
I herebv cer�N ihat I inspected the electrical installatian described herein an the dates stated:
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FOR OFFlCE USE ONLY
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R uest Date: Rough-in Inspection Required? ❑ Yes � No Inspectio� Other Than Rough-In: �Ready Now � Will Cell
You must call the inspector when ready! Date Ready: " � O
I certiiy that I am the �,LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at