P - 79820�.-316-264 �
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REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
7821 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 D � i � 1� ' l . � //L/M
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Amcere � $25
Above 800 Ampere � $75
�UITS / FEEDERS
0 to 200 Ampere � $5
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTROL, SIGI
CUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparetus �$.50
ADDITIONS TO THE GENERAL FEES
_TIFAMILY DWELLINGS (PER UNIn
3 to 12 Units �$50 Per Unit
Each Additional Unft � $25
OTHER ADDITIONAL FEES
Center Pivot Irrigation Boom �
Manufactured Home Park Lots i
Recreational Vehicle Park Sites
Seoarate Bondina Insoeclion �
Standard
indard �
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Transformers u to 10 KVA (� $70
Transformers over 10 KVA � $20
Transformer / Power Supply for Signs / Outline Ugh6nq �$5
ONE & TWO FAMILY DWELLINGS, EACN UNIT
Inciudes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$8(
� Reinspection Fee � $20
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I herebv certHY that I inspected the electrica�
total fee is
herein on tlie detes
Soecial Insoection (� $ 31 per Mile ` _�� `—' � Z �� �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
� FOR OFFICE USE ONLY
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Request Date: . D� i±ough-in Inspection Required? ❑ Yes ❑ No Inspeciion Other Than Rough-In. dy Now 0 Will Call
� V You muffi call the inspector when ready! Date Ready: �
I certi(y ihat I am the�ICENSED CON'fRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical arork ffi: