P - 824271�J24-199 �q :
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Identify the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION E
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am re �$25
401 to 800 Amoere � $50
RE(�UEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OS00 TTY/MRS 1-800-627-3529
www. electriciry. state. mn. us
R e Co n n e.�� F, ,��v;,� p
0 to 200 Am ere �$5
Above 200 Am ere � $t0
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S em Device or ratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Lighting Retrofit � $25 per Fixture
Cemer Pivot Irrigation Boom � $4(
Manufactured Home Park Lots � $
Recreational Vehicle Park Sites �
I I Special Inspection �$.31 per Mile
THIS INSTALLATION MAY BE
Traffic Signal Standard � $5
Supplemental Fee � $20
Transformers uo to 10 KVA �
� Transformer / Power Supply for Signs / Outline Lighting �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two In ion Tri s Each Dwelli Unit �$8(
Additional Insoeclion Trips � $20
Fee
total fee is
that I insoected the electrical installatian described herein on the dates spted:
FOR OFF�E USE ONLY
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Request Date: Rough-in Inspectian Required? ❑ Yes ❑ No Inspe
' "� � You must call Me inspector when readyl Date
I certify that I am the�.LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER
---� t0' � �ec� I
WITHIN 18 MONTH8 _ _ _
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Other Than Rough-In:
and hereby request inspecfion of ihe eledrical wak at