P - 78691REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
�, ��.J �- 7 2 9 � °� �821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us
Identity the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am ere �$25
401 to 800 Amoere � $50
CIRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CO
CIRCUITS, CIRCUITS OF LESS THAN 50
Each Svstem Device or Aooaretus �
MULTIFAMILY DWELLINGS PER
3 to 12 Units �$50 Per UnR
Each Addi�onal Unit � $25
FEES
Retrofit � $25 per Fixtun
'ivot Irrigation Boom � $4
tured Home Pa�k Lots �
m�l Vehicle Pa�C Sites �
� Bondina Insoection � $�
l T�Cf�%��� �
Outdoor
L
Traffic Si nal Standard � $5
Su � lemental Fee � $20
Transfortners u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su for Si r�s / 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 Dwellin Unil �$8f
Additlonal Insoection Trips � $20
:don Fee � $20 " �V
TOTAL F
(minimum total fee is $20);
e acr �O�
UW I inspected the elec[rical insfallation described herein on tl�e dates stated:
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THIS INSTALLATION MAY BE ORDERED DISCtNINECTED IF Nv7 cvMP�t � tu wi � rnn: �ts murv � na
� . FOR OFFICE USE ONLY
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Request ate: Rough-in Inspection Required? Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now Will Call
3 You must call the inspector when ready! Date Ready:
I rtity that I am the�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: