P - 79890REQUEST FOR ELECTRICAL INSPECTION
(� ° Minnesota Board of Electricity
1��. J'� - 213 ��" � �82j University Avenue Suite S-128, Saint Paul, Minnesota 55164
� �� '� (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.sta�e.mn.us �
Identiiy the work covered by this request:
❑NEW ❑REMODEL ❑ADDITION ❑REPAIR
401 to S00 Am ere �$50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am re (� $5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CO
CIRCUITS, CIRCUITS OF LESS THAN 50
Each S tem Device or aratus �
ADDITIONS TO THE GEP
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Retrofit � $25 per Fixture
'ivot Irciaation Boan � S4C
nspection � $21
� $30 uer Fbur
SIGNALING
Outdoor Li htin Standard � $1
Traffic Signal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transiormers over 10 KVA � $20
Transformer / Power Su I for S' ns / Outline Li dn �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Senice andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit (� $8C
Additional InspeCtion Trips � $20
Investiaafrve Fee
FOR OFFICE USE ONLY
11111lil111! �1fll�lllf 1ili111111 fllll iillillll Il1I
�E 1 c 9 1 Z 1 3 5�E
total fee is
29s2�
that I insoected the electrical installation described Fierein an
��g�
I WI7HlN 18 MONTH;
2962��,Sa
adY Now Will Call
� /��' (J� � You must call the inspector when ready! I Date Ready: �
F
I certify that I am tf�LICENSED CONTRACTOF ❑ COMPANY ❑ OWNER and hereby request inspection of the elecfrical work ah