P - 79524REQUEST FOR ELECTRICAL INSPECTION
1�6 8 9 4 2 '�a Minnesota Board of Electricity —
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� ° (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us '�'
Identify the work covered by this request:
❑ NEW ❑ REMODEL , ADDITION ❑ REPAIR
ENERAL FEES
0 to 400 Ampere � $
401 to 800 Amoere �
0 to 2(� Am ere �$5 (
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per UnB
Each Additional Unit � S25
� Retrofft � $25 per Fixture
Pivot IrriaaUon Boom � $4f
Inspection � $21
� $30 �er Hour
Traffic Si nai Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA d$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline U htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Tri s Each Dwellin Unit �$8(
Additional Insoection Trios � $20
Fee �
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R Date: Rough-in Inspection Required? Yes ❑ No Inspecflon Other Than Rough-In: ❑ Ready Now Will Call
� GJ Q� You must call the inspector whe ready! Date Ready:
I cerMy that I am the�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection o1 the electricai work at