P - 78562REQUEST FOR ELECTRICAL INSPECTION
1- � 4 4��� 8 � Minnesota Board of Electriciry
,. 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
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� ��°� (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us _ �
Identity the work covered by this request:
❑ NEW ❑ REMODEL O ADDITION i EPAIR Sj ��. _; �_
401 to 800 Am ere �$50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE C01
CIRCUITS, CIRCUITS OF LESS THAN 50
Each S stem Device or atus �$
ADDITIONS TO THE GEN
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL
CeMer Pivot Irtigation Boom � $
Manufactured Home Park Lots �
Recreational Vehicle Park S�es �
Hour
Outdoor Li htin Standard � $t
Traffic Si nal Standard (� $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Trar�sformers over 10 KVA � $20
Transformer / Power Su for Si ns / Outline Li htln �4 $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelli Unit �$8C
Addftional Insoeetion Trios � �20
Fee �
TOTAL FEE
total fee iS $20) .
that I inspected the electrical installation described herein on tlie dates
I I Special Inspec6on �$.31 per MM�e � �--� f_�,- _,' (.
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFYCE USE ONLY J �
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I certify that I am th�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at