P - 81910� REQUEST FOR ELECTRICAL INSPECTION
Q 4� Minnesota Board of Electricity
1� o J�- 4 9 6�� V. 1821 Universiry Avenue Suite 5-128, Saint Paul, Minnesota 55104
� : (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us
Identify the work covered by this request:
EW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
SERVIGES / POWER SUPPL{ES
0 to 400 re � $25
401 to 800 Am ere (� $50
Above 800 Am re � $75
C RCUITS / FEEDERS
0 to 200 Amoere � $5
;UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Apoaratus �$.50
Retrofit
Outdoor Li htin Standard � $1 _
Traffic Si naf Standard t� $5
Su plemental Fee � $20
Transformers u to 10 KVA f� $10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns ! Outiine Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwel{in Unit �$8(
Additional Insoection Trios � $20
Manufactured Home Park Lots �$25 I hereby cert' mat I in ed u,e
Recreational Vehicle Park Sites �$5 p01�""
Se arate Bondin Ins ection �$20
S ial Ins 'on �$30 r Hour F"""�"�' /'�
Special Ins 'on (� $.31 r Mile v
Tli1S_�iS'CALLAIIQBI MAY 6E _QRDERED DISCONNECTED IF NOT C
FOfl OFFICE USE ONLY
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R uest Date: Rough-in Inspectian Required? es o Inspection Other
���/�0/ You must call the inspector when ready! Date Ready:
total fee is
eledrical i�sfallabon described herein
•
6 �,tz
I certify that 1 am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of tl�e electrical work at: