P - 81827REQUEST FOR ELECTRICAL INSPECTION
� � Minnesota 8oard of Electricity �°°°� �
�� �������� a � id21 University Avenue Suite S-i28, Saint Pau, Minnesota 55104
- �" (651) 642-0800 TfYlMRS 1-800-6273529 �'�11
www.electricity.state.mn.us �Q ��
Identity the work cavered by this request:
❑NEW �iEMODEL ❑ADDITION ❑REPAIR ��� �� Q�1��� �(Q��� ,����Q Q�S
0 to 400 Ampere � $25
401 to S00 Am ere @$50
Above 800 Am ere � $75
IRCUITS ( FEEDERS
0 to 200 Am re C� $5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CI
CIRCUITS, CIRCUITS OF LESS THAN 5i
Each S stem Device or A aratus �
ADDITIONS 70 THE GE
MULTIFAMIIY DWELLINGS PER UNfT
3 to 12 Units �$50 Per Unit
Lighting Retrofd � $25 per Fixture
Center Pivot Irriaation Boom � S4(
Traffic Si nal Standard � $5
Su plemental Fee � $20
Transformers u to 10 KVA �$10
Transtormers over 10 KVA � $20
Transiormer i Power Su I for Si ns / Outline Li Min �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, AN
Circuits and Two Inspection Trips Each Dwellin Unit �$8(
Additional Inspection Trips � $20
Investiaative Fee
total fee is
on me
Se arate Bondin Ins 'on �$2U 'r V
S eciai Ins ion �$30 r Hour ""` "1°�f01 Q�_t�l °�"'�
S ecial Ins ection �$.31 r Mile C7 `G� ~J
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHiN 18 MONTHS
! —'-- -- FOR OFFlCE USE ONIY �
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Reque�-t;:�� � Rough-in tnspectbn Required4 ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now tli CaN
� You must call the inspector when readyl Date Ready:
I certify that { am the tICENSED CANTRACTOR ❑ GOMPANY ❑ OWNER and hereby request inspectio� of the e�ectrica� wo�c at:
Job Address (Street, Box, or Route No.) City Zip�Crod�e t '
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Power Supplier
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