P - 81844REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
, 1-$7rj-40rj � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electriciry. sta te. mn. us
Identity the work covered by this request:
O�LIEW ❑ REMODEL ❑ ADDITION 0 REPAIR
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
TIFAMILY DWELLINGS (PER UNIT
3 to 12 Units �$5a Per U�it
Each Additional Unit � $25
OTHER ADDITIOI
Lighting Retrofit � $25 per Fi�ure
Center Pivot Irriqation Boom � $40
Transformers over 10 KVA � $20
Transformers / Power Supply for Signs / Outline Lighting 4� $;
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Pawer Supply up to 500 Amperes, EUI
Circuits and Two Inspection Trips Each Dwelling Unit �;680
Additlonal lnspection Trips � $20
Investigative Fee
� Reinspection Fce � $20
FOR INSPECTOR USE ONLY
1 hereby cehity Mat I inspecled �he eleciricel installalion descAbeE herain on the detes steted:�
RWGM IN DATE
FINpL iNSPECTION � . DATE
FOR OFF7CE USE ONLY
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IRequest Date: Rough-in Inspection Required7 O Yes 0 Inspection Other Than Rough-in: eady Now ❑ Will Call
0 18l01 You must call the inspector when ready! Date Ready:
� I certif�r that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: