P - 82443� =028-059 � v�
� �� mA; �
Identify the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am ere �$25
401 to 800 Am ere �$50
Above 800 Am re � $75
CIRCUITS / FEEDERS
0 to 200 Am re �$5
Above 200 Am re � $70
ALARM, COMMUNICATION, REMOTE CON
CIRCUITS, CIRCUITS OF LESS THAN 50 \
Each S tem Device or ratus �$.
ADDITIONS TO THE GENE
MULTIFAMILY DWELLINGS (PER UNITI
OTHER ADDITIONAL FEES
Manufactured Home Park LoGs �
Recrealional Vehicle Park Sites �
Mile
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. e lectricity. state. mn. us
� e�n n 2c'� �u i� n ac e..
Outdoor Li htin Standard � $1
7raffic Si nal Standard � $5
Su lemental Fee � $20
Trans(ormers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transfortner / Power Su I for Si ns / Outline Li h6n �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
GNALING Circuits and Two Inspection Tri Each Dwellin Unit �$80
Additional Ins ection Tri � $20
InvestiaaWe Fee
total fee is
! herebvi certiN that I i�oected the eleGrical installation desa�ed herein on
FOR OFFICE USE ONIY
i iiii�i ��i�i �iiii ft�i� �i��i �� � �iiii fii� iiii -a �
� s aeeos�e � �b'S ��1p�7�-1
Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection pUrer Than Rough-In: Ready Now ❑ Will Call
p� q—CJv You must call the inspector when readyl Date Ready;
I certiTy that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection oi the electrical work at