P - 817661-C�n6-568 ��
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Itlentify the work covered by this request:
❑ NEW ❑ REMODEL ❑ADDITION ❑ REPAIR
0 to 400 Am ere �$2;
401 to 80o Am re� 9
Above 800 Am re � 3
CIRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am ere � 9
ALARM, COMMUNICATION,
CIRCUITS, CIRCUITS OF LI
Each S tem Device or
ADDITIONS
irsva
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
, � ����. `S
REMOTE CONTROL, SIGNALING
SS THAN 50 VOLTS
400aratus � $.50
Lighting Retro(il � $25 per Fn
Center Pivot Irrigation Boom �
Manufactured Home Park Lots
� $� DBf HOUf
Outdoor Li htln Standard � $1
Traffic Si nal Standard � $5
Su lemental Fee � $20
7ransformers u to 10 KVA �$10
Transiormers over 10 KVA � $20
Transformer / Power Su I(or Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 500 Amperes, All
Circuits and Two Ins ection Trips Each Dwellin Unit �$8(
Additional Ins ectbn Tri s�$20
Investiqative Fee Q
Reinsoection Fee � $20
total fee is
I in�ecied the electrical inspllatbn des�xibed her�n an
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1 III1il f�1i1 Il111 i#ifl !{II1 IMI� 11111 �III i111 y�. �•
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Request ate: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: Ready Now Q�II Call �
' " D � Ynu must call the inspector when readyl Date Ready:
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe electrical work at