P - 77709REQUEST FOR ELECTRICAL INSPECTION
�. .7 �F � 4 9 7, Minnesota Board of Electricity
��� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627 529 -
www.electricity.state.mn.us �U�S ' ( / � b� /
Itlentity the work covered by this request:
❑ NEW C1dREMODEL [$7�DDITION ❑ REPAIR
GENERAL FEES
SERVICES I POWER SUPPLIES
0 to 400 Am re �
407 to 800 Am re �$50
Above 800 Am re � $75
CIRCUITS / FEEDERS
0 to 200 Amoere � 3B�
IMMUNICATION, REMOTE CONTROL,
CIRCUITS OF LESS THAN 50 VOLTS
ystem Device or Aooaratus � $.50
MULTIFAMILY DWELLINGS PER UNI
3 to 12 UniGs �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fixture
Center Pivot Irri tion Boom �$40
Manufactured Home Park Lots � $25
Recreational Vehi�e Park Sites � $5
Se arate Bondin Ins ection �$20
S ial Ins 'on �$30 r Hour
Special Inspection � $.31 cer Mile
_ THIS INSTI
FOR OFFICE USE ONLY
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R�est qete� � Rough-in Inspection Required? Yes ❑ No Inspf
J(� You must call the inspector when ready! Date
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY �WNER
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Su demental Fee � $20 fj0�
Transfortners u to 10 KVA �$10 �
Transformers over 10 KVA � $20
Transformer I Power Su for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Suppty up to 500 Amperes, All
CircuHs and Two In ion Trips Each Dwellin Unit �$8f
Addi6onal Inspectbn Tri� � $20
Investiaative Fee
I insoected Uie
IF NOT
Than Rough-In:
total fee
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described herein on the dates stated:
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WITHIN 38�MONTHS
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Will Call
and hereby request inspection of the electrical work at: