P - 80478� REQUEST FOR ELECTRICAL 1NSPECTION
Minnesota Board of Electricity °
�' 1-381-449 � 1821 University Avenue Suite S-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:
❑'ICEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
to
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL f
MULTIfAMILY DWELLINGS (PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 er Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots � $25
fiecreatlonal Vehicle Park Sites � $5
XCEL ENERGY SAVER'� SWITGH
Treffic Si nal Standard � $5
Su lemental Fee � $20
Transformere u to 10 KVA �$10
Transfortners overl0 KVA � $20
Transformers / Power Su I for Si ns / Outline Li htin �$!
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Twa Inspection Trips Each Dwelling Unit �$60
Additional Insoec6on Trios � $20
FOflINSPECTOR
i nereoy cen�ry me� i
ROUGH IN
FINAI. INSPECTION
TOTAL FEE
�I fee is $20)
on me dsres smtea:
DATE
FOR OFFlCE USE ONLV
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* 1 381 4496* c��'�" _
Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-in: Ready Now ❑ Will Ca�l
09/28/01 You must call the inspector when ready! Date Ready:
I certity that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: