P - 79653REQUEST FOR ELECTRICAL INSPECTION
� � � � � � � � � � �9+nr�eeie 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 '� �
IdentiTy the work covered by this request:
❑ NEW O REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
0 to 400 Am ere �$
401 to 800 Am ere �
Above 800 Am re �
CIfiCUITS / FEEDERS
0 to 200 Amoere � $
RM, COMMUNICATION, REMOTE CONTROL, SIGNALING
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
.TIFAMILY DWELLINGS PER UNI
3 to 12 Units (� $50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofrt �$25 er Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots � $25
Recreational Vehide Park Sites � $5 . .
� )
A_S 1 � I` I %���
Outdoor Li htin St dard �$1
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$8f
Additional Ins ection Tri s�$20
Investiaative Fee
tOtdl f22 IS
FOR OFFICE USE ONLY
� ������ I���� ����I i���� �I��I ���1� ���II l�l�� II�� I��� , Q,#`
3E i 1 8 4 1 4 5 9�E �C ���� O�d-.�'C�
Request at� �� Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: Ready Now ❑�II Call
3 You must call the inspector when readyl Date Ready:
I certity that I am the �LtCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection oi the electrical work at