P - 81926REQUEST FOR ELECTRICAL INSPECTION
1'� � � V� H J H Minnesota Board of Electricity "`Y`
�
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
„ e� � (651) 642-0800 TTY/MRS 1-800-627-3529
www. electrici ry. state. mn. us
Identity the work covered 6y this request:
❑ NEW ❑ REMODEL ❑ ADDITION �
GENERAL FEES
0 to 400 Ampere � $
401 to S00 Amoere �
0 to 200 Amoere �
CIRCUITS OF LESS THAN 50 VOLTS
ystem Device or Apparatus � $.50
ADDITIONS TO THE GENERAL FEES
Lighting Retrofit � $25 per Fixtu
Center Pivot Irrigation Boom � $
Manufactured Home Park Lois �
� $.31 ner Mile
Outdoor Lighting Standard �
Traffic Signal Standard � $5
Suppiemental Fee � $20
Transformers up to t0 KVA (�
Trensformers over 10 KVA �
� Transformer / Power Supply for Signs / Outline LighGng �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Ins 'on Trips Each Dwellin Unit �$&
AddiUonal Insoection Trios � $20
Fee
I insoected the
total fee is
_-_.► frd' ^c�
WITHIN 18 MONT1iS
FOR OFF�E USE ONLY
i ���{{i �ii�� Eii�� �iii� iiii{ ii� fi�ii ���i ii�i � � ,��� �
� 1 1 D 6 8 5 B 2� �����
R est Date: Rough-in Inspectbn Required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now �II Call
�� OC /� �� You must call the inspector when ready! Date Ready:
I certify that I am the �.LICENSED CONTRACTOR ❑ GOMPANY ❑ OWNER and hereby request inspection of the electrical wo�C at