P - 81911REQUEST FOR ELEC7RICAL 4NSPECTION
Minnesota Board of Electricity '�
1� 0 5 3���� �±�'� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�' ��� �� (65i) 642-0800 7TY/MRS 1-800-627-3529
www.electricity.state.nan.us ^
IdeMitv the work cavered bv this reauest:
❑NEW I
SERVICES / P(
0 to 400 Ai
401 to 800
Above 800
CIRCUITS / FE
• 0 to 200 Ai
Above 200
ALARM, COMN
CIRCUITS, CIR
Each Svste
❑ ADDITION ❑ REPAIR
7
ere � $5
npere (� $10
JICATION, REMOTE CONTROL, SIG
IITS OF LESS THAN 50 VOITS
Device or Apparaws � $.50
DDITIONS TO THE GENERAL FEES
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Liyhting Retrofit � $25 per Fixture
Center Pivot Irtigation Boom � $40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites � $5� .,.
Outdoor Li htin StarWard � $1
Traftic Si nal Standard � $5
Su Iemental Fee � $20
Transformers u to 10 KVA �$10
7ransformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINCaS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, Nl
Circufts and Two Inspection Trips Each Dwelling Unit �$SL
Fee �
total fee is
the electrical installadan described herein on
Saecial Inspection +� $ 31 per Mife 7'�� ��r
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFRCE U6E ONLY
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11
� 1 O S 3 4 3 7 Ei �E
Request Date: RougMn Inspection Required? ❑ Yes o InspecUOn Other Than Rough-In: ❑ Ready Now Cali
� You must call the inspector when readyl Date Ready:
i certity that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of Uie electrical work at: