P - 81775REQUEST FOR ELECTF�ICAL INSPECTION
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Minnesota Board of Electricity "`
1� V 6 9-17 7"� 182� University Avenue Suite S-128, Saint Paul, Minnesota 55104 i�
i e� � (651) 642-0800 TTY/MRS 1-800-627-3529
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www. electricaty. state. mn. us
Identify the work covered by this request:
❑ NEW REMODEL ❑ADDITION ❑ REPAIR
GENERAL FEES
SERVICES I POWER SUPPLIES
0 to 400 Amcere � $25
800 Ampere �
/FEEDERS
Above 200 Am ere � $10 ' "
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Eact� tem Device or A ratus �$.50
ADDITIONS TO THE GENERAL FEES
Unit � $25
OTHER ADDITIONAL FEES
� S25 oer Fixture
I Home Park Lots �
Vehide Park Sites �
idina Insoection � $:
0
Outdoor Lighting Standarc
Traffic Sianal Standard �
Transfortners over 10 KVA � $20
Transformer / Power Suppty for Signs / Outline Lighting �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Tri s Each Dwellin Unit �$8C
Addftional Ins ection Tri s�$20
Investi ative Fee
Reinsoectbn Fee � $20
total fee is $20)�5((J,
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Special Inspection �$.31 per Mile J
TNIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
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Request Date: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Call
�- �° V 1 You must call the inspector when ready! Date Ready:
I certify that I am the ,�LlCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspectiorr of the electrical work at: