P - 786211�-29�7-472 �
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
Identify the work covered by this request: `^ ,r� /� /'� �%
� � r� � ��. cv , .y
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIFi �T(�_
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am re �$25
401 to 800 Am re �$50
Above 800 Am re � $75
CIRCUITS / FEEDERS
0 to 200 Am re�$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S tem Device or aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unk
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fucture
Center Pivot Irri ation Boom �$40
Manufac►ured Home Park Lots � $25
Recreational Vehicle Park Sites � t f
Outdoor
Standard
Trar�sformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transfamer / Power Supply for Signs / Outline Lighdng �$5
ONE & NVO FAMILY DWELLINGS, EACH UNR
Includes the Service andlor Power Supply up to 500-Amperes, All
Circuits and Two Inspection Trips Each DweHing Unit �$8(
� Reinspection Fee � $20
FOp INSPECfOfl USE ONLY
J
I herebvi cerfify tliat I inspeded tlre electrical
total fee is
herein on �e de�s
;ial Ins ection � $.31 Mile ��`�—
IS INSTALLATION MAY BE ORDERED DISCONNECTED IF COMPLETED WITHI�
� o� use orur
I i�ll�I IIIII iiIII IIIIi IINIlIIII II�I IIIII IIII IIII �����
� 1 2 9 T 4 7� i�E
�—��� �
�J, Sb
Now wn cen
I// �? /Q3 I You must call the inspedor when readyl , I Date Ready: I
I certity that I am the �UCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electric�l work at