P - 795501.-'272-359 A� �
� �v� �a
Identity the wark covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am re �$25
401 to 800 Am ere �$50
Above 800 Ampere � $75
Above 200 Am ere C� $10
ALARM, COMMUNICATION, REMOTE CONTR(
CIRCUITS, CIRCUITS OF LESS THAN 50 VOL
Each S stem Device or ratus �$.50
ADDITIONS TO THE GENERAI
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Addftional Unit � $25
OTHER ADDITIONAL FEE
mgatan Boom � $
Home Park Lots �
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity —
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. e lectricity. state. mn. us
iiC> �, / ( G � /C-
Outdoor Li htin Standard � $1
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I 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
3NALING Circuits and Two Inspection Trips Each Dwellin Unit �$80
Additional Ins ection Tri � $20
Investi ative Fee
S Reinsoection Fee � $20
u
total fee is
I hereby certily Mat I inspec[ed the elecTrical instailati�on desaibed herein on tlre dete,a stated:
S ial Ins ion �$30 r Hour ' """��E���+ �h
S ial Ins ectbn �$.31 rAMle �Z-2-3—a3
THIS INSTALLATION MAY BE ORDERED DISCONNECTED 1 OT COMPLETEp WITH�N ia nnnNTHC_
FOR OFFlCE USE ONLY
I ililll �li�i IIIII illll illll IIIII IlILI IIllI NII i�11 � `�,
���� C
�E 1 c 7 Z 3 5 9 9�E � �"' `� �
Request Date: Rough-in Inspection Required? ❑ Yes Inspection Other�ou h-In. Now � W/fll Call
You must call the inspector when ready! Date Ready: �•
I certifv that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecUon of the electrical work at:
ta„�,�,�,�„-�s „„�,,,,,, ---- - - --