P - 81843� r REQUEST FOR EL�CTRICAL INSPECTION
Minnesota Board of Electrieity
�� 1-375-404 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. s ta te. mn. us
Identity the work covered by this request:
OMIEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
SERVICES 1 POWER SUPPLIES
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS (PER UNI
3 to 12 Units (� $50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retroffi �$25 per Fixture
Center Pivot Irri a6on Boom �$40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites �$5 �
Se arete Bondin Ins 'on � $20
S ial In 'on �$30 r Hour
Scedal Insoection � 8.31 oer Mile
XCEL ENERGY SAVER'� SWITCH
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformers I Power Supply for Signs / Outline Lighting �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$SO
Additional Inspectlon Trips � $20
pe
Investi ative Fee
Reinspection Fee � $20
TOTAL FEE
(minimum total fee is $20)
FOR INSPECTOR USE ONLY .
I �ereby certify that I inspected the electricel installation described herein on the detes sleteC:
RWGH IN DATE
FINF� INSPECTION DA7F
� � 26- a(
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTMS
FOR OFFlCE USE ONLY
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* 1 3754049'� �'��17�
Request Date: Rough-in Inspection Required? OYes ❑ Inspection Other Than Rough-in: eady Now I� Will Call
�F ��1 You must call the inspector when ready! Date Ready:
I certify that I am the � LICENSED CONTFiACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: