P - 78710REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity '�
1� 16 4-19 8 q 182� ����e�s��, A�e��e S��=e S-12S, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 -
' www.electricity.state.mn.us
Identity the work covered by this request:
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❑ NEW ❑ REMODEL�DDITION ❑
401 to 800 Ampere � $50
Above 800 Ampere � $75
CUITS / FEEDERS
0 to 200 Ampere � $5
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTROL, SIG,
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
.TIFAMILY DWELLINGS (PEH UNIT)
3 to 12 UniGs �$50 Per Unit
Each Addidonal Unit � $25
OTHER ADDITIONAL FEES
Pivot
Park Sites �
Mile
Traff'�c Si� nal Standard � $5
Su �lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppy up to 500 Amperes, All
CircuiGS and Two Inspection Tri Each Dwelli Unit �$8(
Additional lnsoec6on Trios � S20
I inscected Me electrical irrefallatlon
total fee is
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FOR OFFlCE USE ONLY �7'��� --' — — —
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Request Date: Rough-in Inspection Requireil? ❑ Yes No Inspection Other Than Rough-In: Ready Now ❑�tl Call
��' �' o� You must call the inspector when ready! Date Ready: �
I certi(y that I am the ❑ LICENSED CONTAACTOR ❑ COMPANY ❑ OWNER and hereby request inspectiai of the electrical work at: