P - 79516� REQUEST FOR ELECTRICAL INSPECTION
° Minnesota Board of Electricity "
�� 2 3 5� V H� v° ,, ° 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� m� (651) 642-0800 TTY/MRS 1-800-627-3529
� 3 � www.electricity.state.mn.us
Identify the work covered by this request: � �� ���(
afdNEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoa Lighting Standard �$1 __
401 to 800 Ampere � $50
Above 800 Am ere (� $75
�UITS 1 FEEDERS
0 to 200 Ampere � $5
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTROL, SIGI
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
.TIFAMILY DWELLINGS (PER UNI�
3 to 12 Units �$50 Per Untl
Retrofit � $25 per Fixture
'ivot Irtiaatlon Boom � $4fi
Inspection � $21
� $30 oer Hour
Traffic Si nal Standard (� $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer ! Power Su I for Si ns / Outline Li hfin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$8(
Additional Inspection Trips � $20
Investiaative Fee
1 herebvi certiN that i inspected the
total fee is
the dates steted:
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FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now ill Call
ou must call the inspector when ready! Date Ready:
I certiiy that I am the �'CICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at