P - 824421-028-058�g°
Identify the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION
0 to 400 Ampere � $25
401 to 800 Ampere � $50
Above 800 Ampere � $75
�UITS / FEEDERS
0 to 200 Ampere � $5
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTROL,
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Apparatus �$.50
OTHER
Manufactured Home Park Lots �
� $30 per Hour
� $.31 ner Mile
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn. us
��nne�� �ur Q�e,
Outdoor Li htin Standard � $1
Traffic Si nal Standard � $5
Sup lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
I 7ransformer / Power Supply for Signs / OutGne Lighting �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inscection Trios Each Dwellinp Unit �$Sf
Fee �
total fee is
insfsllation descr�ed herein on Ihe dates
l0 � � /
) TH
FOR OFFICE USE ONLY
IlllllflllllllllllllllllllCEl IllllIllllllll , �.? "
* � azs0584 * ao,�° �� `�
Re,9 �est Date: Rough-in Inspecfion Required? ❑ Yes ❑ No Inspection Other Than Rough-In: eady Now ❑ Wdl Call
(��R—oO You must call the inspector when ready! Date Ready:
I certity that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspectiai of the electrical work at