P - 784171-34�7-330 �P �a
Identify the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
0 to 400 Ampere � $;
401 to 800 Amcere �
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTROL,
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaraius ��.50
OTHER ADDITIONAL FEES
Manufactured Home Park Lots �
iecial Inspection � $30 per Hour
�eaal Inspection � $.31 per Mile
'HIS INSTALLATION MAY B
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electriciry
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-6273529
www. electri ci ty. state. mn. us
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Outdoor Liah6na Standard � $1
Su lemental Fee � $20
Trensformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLIN�S, EACH UNIT
Includes lhe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$80
AddiUonal Insoection Trius � $20
(minimum total fee is $20) }��y •.
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I herebvi certlfv that I inspected the electrical installetion described herein on tlie dates slated:
FOR OFFN:E t/8E ONLY
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Request Date: Rough-in Inspectfon Required? �'Yes ❑ No InspecUon Other Than Rough-In: ❑ Ready Now �VUill Calf
g' 1� � V�./ You must call the inspector when readyl Date Ready:
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY �OWNER and hereby request inspection of the electricai work at: