P - 80122REQUEST FOR ELECTRICAL INSPECTION
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1�3 2 6 4 9 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
Identify the wark covered hy this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am ere �$25
401 to 800 Am ere �$50
Above 800 Ampere � $75
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIfAMILY DWELLINGS IPEH UNITI
Retrofit � $25 cer Flxture
Aecreafional Vehicle Park SRes �
Seoarate Bondina Insoection � �
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TraHic Si nal Standard (� $5
Su lemental Fee � $20
Transformers u to 10 KVA �$1�
Transformers over 10 KVA � $20
Translormer / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two fns ion Trips Each Dwellin Unit �$Bt
Additional Insoection TriDS � $20
Fee
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total fee is
on Ihe detes slated:
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Special Inspection �$.31 per Mile _/'� �� z� �
THIS INSTALLATION MAY BE ORDERED DISCONNE NOT COMPLETED WITHIN 18 MONTHS
FOR OFFlCE USE ONLY
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Reque Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now � WiN Cell
" —� You must call the inspector when readyl Date Ready:
I certity that I am the ❑ IICENSED CONTRACTOR ❑ COMPANY ❑ OWNEH and hereby request inspection of the electricai work at: