P - 76212REQUEST FOR ELECTRICAL INSPECTION ���'
� � � � � � 4 � � � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
s r (651) 642-0800 T'fY/IMRS 1-500-627-3529 www.edectricity.state.mn.us
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SERVICES / POWER SUPPLIES
U to 400 Ampere @ $25
401 to B00 Am ere c$50
Above 800 Am re $75
CIRCUITS / FEEDERS
0 to 200 Am $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, GIRCUITS OF LESS THAN 50 VOLTS
Each S m bevice or Apparatus $.50
ADDITIONS TO THE GENERAL I
MULTIFAMILY DWELLINGS PER UN
3 to 12 Units @$50 Per Unit
Each Addfional Unit @ $25
OTHER ADDRIONAL FEE:
Lightlr�g Retrofit � $.25 r Fixture
Ce�er Pivot irrigation Boom $40
Manufactured Home Park Lots $25
R�reafional Vehide Perk Sit� $5
Se Band' Ins 'on $20
St�c1al InssaecNon Ca� $30 per Hour
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182�4750
Standard
ONE & TWO FAMILY DNIELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 5� Amper�s, All
Circuifs and Two Ins�Uon Trips Each Dwelling Unit @$80
(minimum total fee is $20) �
7HI9 AI�A FOR P6�EC�OR U� MRY
I hereby certHythat I I�eded fhe electrfcai h�staVatlon d�d herein on the c
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��� Rough-in Inspedion Required7 L] Yea �1$a InspecUon Other Than Rough-In: 0 Ready Now Witl CeII
�(% �� You must call the �ctor when readyl Date Ready:
I certify that I am the �L.ICENSED COMRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site SVaet Address C�y^,
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