P - 81632REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity =�
y� - 0 4 9- 3 81 �� 182� University Avenue Suite S-128, Saint Paul, Minnesota 55104
a � (651) 642-0800 TTY/MRS 1-800-627-3529
� '7 `� C.�j „ www.electricity.state.mn.us
Identify the work covered by this request:
❑NEW EMODEL ❑ADDITION ❑REPAIR
GENERAL FEES
Traffic Signal Standard �
Suoolemental Fee � $20
401 to 800 Ampere �
Above 800 Amoere �
IRGUITS / FEEDERS Transformer / Power Su for Si ns / Outline Li htln �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Inciudes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$8(
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S stem Device or atus (� $.50 InvesY ative Fee
ADDITIONS TO THE GENERAL FEES Reins ction Fee (� $20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$50 Per UnR (minimum total fee is $20
EeCh Additi0nel UOit �$25 :OH INSPECTOfl USE dlLV
Manufactured
Recreatlonal'
:5 per Fixture
Boom � $4f
� $.31 oer Mile
FOR OFRCE U8E OfAY
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Request Date: Rough-in InspecBOn Required? ❑ Yes No Ins ion Other Than Rou h-In:
�y..�� p�' g ❑ Ready Now Wiil Call
'� �—lJ �J You must call the inspector when ready! Date Ready:
I certify that I am the �LICENSED COMRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecUon of the electrical work ar