P - 795791-154-099 � �
���° � z
Identify the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION
GENERAL F
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 Amoere � $5
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus �$.50
Y
OTHER ADDITIONAL FEES
Lighbng Retrofit � $25 per Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots � $25
Recreational Vehide Park Sites � $5
Separate Bonding I�spection � $20
Soecial Insoection � S30 oer Hour
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity =
i82i Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electriciry.state.mn. us
���� �i��-F��
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li hti �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unft �$8f
Additional Insoection Trios � $20
total fee is
I hereby certity Nat t inspected the electrical insteNalion described herein on fhe datea
�uc�x rc� c
FOR OFRCE USE OlILY
i��}�� �f��� �i�i� �r��i ����� «��� �i��� ����� ��i� �«� ��a
� 1 1 5 4 O 9 9 4* �77 `�
� ����[� � You must call the inspector when readyl � Date Ready: �
I certi(y that I am the,�{ICENSED CANTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at