P - 78739REQUEST FOR ELECTRICAL INSPECTION
����� � O� v�e Minnesota Board of Electricity
') � � v 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� (651) 642-OE00 TTY/MRS 1-800-627-3529
www. electricity.state.mn. us
Identify the work covered by this request: OD� n�' � ' ��
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❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Liphting Standard �$1
SERVICES I POWER SUPPLIES
0 to 400 Am ere �$25
401 to 800 Am re�$50
Above S00 Ampere � $75
:UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL i
TIFAMILY DWELLINGS (PER UNIn
3 to 12 Units �$50 Per Unit
Fach AdAitional Unit � $25
Park Lots �
Park Sites �
Transformers over 10 KVA � �20
Transfortner / Power Suppty for Signs I OuHine Lighting �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Indudes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$8(
Additional Ins ection Tri s�$20
Investi ative Fee
Reins ection Fee � $20
TOTAL FEI
Iminimum total fee is $20
I hetebv ceRiN that I inspected the
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Request te: Rough-in Inspection Required? Yes ❑ No Inspection Other Than Roggh-In: ❑ Ready Now Cak
�' Z 03 You must call the inspector when ready! Date Ready:
.,� certiTy that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY OWNER and hereby request inspection of the electrical wo�k at '
Job Address (Street, Box, or Roule No.j ��b Z�P�����
�ion Township Range Fi� o. Cou �
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Occupant Phone
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Power Supplier A�fB� ,! �.� ..ir F,� i
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rical Contractor / Company Name
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ig Address (CoMrador, Company or Owner Perfortning
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,��ad c�nnar�re lCent�tor. CniA� v or Owner P�erfoi
License
License
Installation) P�e
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BOARD OF ELECTRICITV COPY INSTRUCTIONS ON BACK OF YELLOW COPY