P - 786141,-305-947
Identify the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION
9.to 400 Ampere � $
401 to 800 Ampere �
Above 800 Amoere �
� Above 200 Ampere f� $10
ALARM, COMMUNICATION, REMOTE �
CIRCUITS, CIRCUITS OF LESS THAN
Each System Device or Apparatus
ADDITIONS TO THE G
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 UniGs �$50 Per Unit
Each Additro�al Unit � $25
OTHER ADDITIOP
Li htln Retrofk �$25 er Fucture
Center Pbot Irri ation Boom �$4U
Manufactured Home Park Lots � $
Recreational Vehicle Park Sites � :
�
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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
SC �-V iC� C�-:�4�1 C'iG�
Outdoor Li htin Standard � $1
Traific Si nal Standard � $5
Su lemental Fee � $20
Transtortners u to 10 KVA (� $10
Transformers over 10 KVA � $20
Trensformer / Power Su for Si ns / Outline ' htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
GNALING CircuBs and Two Ins ection Trips Each Dwellin Unft �$80
Additional Ins ection Tri � $20
Investiaative Fee
total fee is
that I inspeded the electrical installation described herein on the detes stated:
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FOR OFFICE USE ONLY
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�ate: Rough-in Inspectlon Required? ❑ Yes Inspection Other Than Rou h-In� ❑ Ready Now ill Call
3I o3 9 �
You must call the inspector when ready! Date Ready:
I certify that,l am the �CICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work ai: