P - 78634� REQUEST FOR ELECTRICAL INSPECTION
,1 3 3 9 4 8 4 "�° Minnesota Board of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
°� (651) 642-0800 TTY/MRS 1-800-627-3529
www. electriciry. state. mn. us
Identity the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
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 � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S tem Device or A ratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS (PER UNITI
Retrofit � $.25 cer Fxture
�
�CaN�v�c`T� ��1���9��
Outdoor Liahtlna Standard � $1
Traific Si nal Standard � $5
Su demental Fee � $20
Transfortners u to 10 KVA �$10
Trensformers over 10 KVA � $20
Transfortner / Power Su I for Si ns / Outline U hti �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and�or Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$8(
Additional Insoection Trios � $20
Fee
I herebvi ceAiN that I insoected the elec[rical installatron
total fee is
Recreational Vehicle Park Sites Q S5 ��- `"""' "" """
S arate Bondi Ins �on e a20
S ecial In ion �$30 r Fbur �""' �, Z�°A�3
S'al In ion �$.31 r A�de
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS ,
FOR OFFK� USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No tnspection Other Than Rough-Im ❑ Ready Now I Call
'"' / J' 0 3 You must call the inspector when ready! Date Ready:
i ce�ity that I am t e_ ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: