P - 79871REQUEST FOR ELECTRICAL INSPECTION
'' tl° Minnesota Board of Electricity
1� 2 4 4- 5 9 2 r y82� University Avenue Suite S-128, Saint Paul, Minnesota 55104
a ��" (651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. state. mn. us
IdO�Crty the work covered by this request:
❑NEW REMODEL ❑ADDITION ❑REPAIR ��'� ' '��� J\ � U
GENERAL FEES Outdoor Lighting Standard �$1
to 400 A
401 to 800
Above 800
;UITS / FE
0 to 200 A
�$
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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 Unit
Retrofit � $25 oer Fixture
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Traffic Signal Standard � $5
Supplemental Fee � $20
Transformers up to 10 KVA �$10
Transfortners over 10 KVA � $20
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� Transformer / Power Suppty for Signs / Outline Lighting �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelli Unit �$8(
AddiGonal Inspection Trips � $20
Investiaative Fee
USEONIY ..-.•�
that I insoected the
um total fee is $20M
29s���
n described herein on the dati
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S ial Ins ion �$30 r Hour '�"�'"""' �^ � 0""e� I
Special Inspection �$.31 per Mile ` J"'�` l
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT GOMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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R�ate: e� Rough-in Inspection Required? Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now itl Call
�� You must call the inspector when ready! Date Ready:
i ceRAy that 1 am the ❑ UCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work aY.