P - 817671-079-081 � �6�
Identify the work covered by this request:
❑ NEW ❑ REMODEL I�ADDITION ❑ REPAIR
0 to 400 Ampere � $25
401 to 800 Am ere �$50
Above 800 Ampere � $75
CIRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTRO
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLT
Each S stem Device or A ratus �$.50
ADDITIONS TO THE GENERAL
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
Lighting Retrofit � $.25 per Flxture
Center Pivot Irrigation Boom � $40
Manufactured Home Park Lots � $
Recreational Vehicle Park Sites � I
Separate Bonding Inspection � $2(
S ecial Ins ection �$30 r Hour
REQUFST FO:R ELECTRICAL INSPECTION
Minnesota Board of Electricity ""'�
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS i-800-627-3529
www.electricity.state.mn.us
�de Gx�S�� .S�n��c �'!t� ib� linlal��v�►
Outdoor L htin Standard � $1
Tra�c Si nal Standard � $5
,D Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and�or Power Supply up to 500 Amperes, All
GNALING CircuiGs and Two Inspection Tri s Each Dwellin Unit �$80
Additional In ion Tri s�$20
Investiaative Fee
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I herebvi certifv that I insoected the
total fee is
on tl�e detes Stete(k
S ecial In ection �$.31 e�r Mile_ __ � �`��� Y'i�"�� �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NO COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Request Date: RougMin Inspection Required? ❑ Yes No Inspecdon Other Than Rough-fn: Ready Now WrN Cal!
�' y �Q �v � You must call Vie inspec[or when ready! Date Ready: � tl� 0 r �•
I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrica� work at
E&00001A-13 7/1/2000 � BOARD OF ELECTAICRY COPY IN87AUC7bNS ON BACK OF YELL0IM COPV