P - 81785� _ REGtUEST FOR ELECTRICAL INSPECTION
� � � � � � � � Minnesota Board of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 551D4
�_ `
��� (651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. state. mn. us �
Identify the work covered by this request:
❑NEW �EMODEL ❑ADDITtON ❑REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 4� Am re � $25
401 to B00 Am ere �$50
Above 800 Am ere � $75
CIRCUITS I FEEDERS
0 to 200 Am ere �$5
Above 200 Am re � $10
AtARM, COMMUNICATION, REMOTE CONTROL, SI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S tem Device or A ratus �$.50
ADDITIONS TO THE GENERAL FEE
Retrofit �
Boom � $
ark Lots �
FEES
Outdoor Lighting Standard � $1
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$tQ
Transfortners over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelli Unit �$80
Additional Inspection Trips � $20
�Investiaative Fee --
total fee is
N� /3� 6,0/
�/�( . j o i[fJ� o�
I herebvi certiN tlaat I inspected tlie electrice� insta0suon descxibed hereio on
FOR OFFlCE USE OIlLY
� �����i ����� ����� ��I�i ��1�` I��������� �i�l i��� �' � a�sy
� i O 3 8 1 3 6 6�E ����
Requ ie: Rough-fn Inspectiort Required? ❑ Yes No Inspeclion Otlier
Q You must call the inspector when readyl Date Ready:
�
u
o`t'--�
I certify that I am the� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request irupection of the elect�ical work at