P - 79903REQUEST FOR ELECTRICAL INSPECTION
(� /� Minnesota Board of Electricity �'�
1� 2�.J `i. � g 3 1 �p �'� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� '� " (651) 642-0800 TTY/MRS 1-800-6273529
www.electricity.state.mn.us '� '
Identity the work covered by this request:
❑ NEW ,�REMODEL ❑ADDITION ❑ REPAIR
GENERAL FEES
S RVICES I POWER SUPPIIES
to 40Q Am ere (� $25
401 to 800 Amoere � $50
0 to 200 Amoere �
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
.TIFAMILY DWELLINGS (PER UNIn
3 to 12 Units �$50 Per Unit
Each Additional Unit (� $25
OTHER ADDITIONAL FEES
Lighting Retrofd � $25 per Fxture
CeMer Pivot Irrigation Boom � $40
Manufactured Home Park Lots � �25 � �
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Outdoor Li htin Standard � $1
Traffic Siqnal Standard � $5
Su lemental Fee � $20
Transtormers u to 10 KVA �$10
Transfortners over 16 KVA � $20
Transfortner / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$8L
Fee �
Fpi INSPECTOP USE ONLY
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I hereby ceAifY mat I ins�
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total fee is $20) y�C.O
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;cribed herein on ihe dates stated:
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TH15 INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? es ❑ No �Inspection Other Than Rough-In: ❑ Ready Now ill Call
6- 2 4- 0 2 You must call fhe inspector when readyl Date Ready:
I certify that I am the�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby requesYinspection of the elechical work aC