P - 77649/� REQUEST FOR ELECTRIC INSPECTION
1� 5 4���F �� � Minnesota Board of ElecVicity �Q('�- D���3
1821 University Avenue Suite S-128, Sein4 Paul, innesota
- (651) 642-0800 T1Y/MRS 1-800�27-3529 www.electricity.state.mn.us
❑ NEW ❑ REMO L 0 ADDITION � REPAIR Describe -using the back of the white cop if necessary - the work covered by this``� �
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GENERAL FEES Outdoar Li htin Standard $1
SERVICES I POWE UPPLIES Traffic S' nal Standard ES
0 to 400 Am e S25 Su mental Fee E20
401 to 800 Am Transformers u to 10 KVA $10
Above 800 Am e E75 Transiortners over 10 KVA S 20
CIRCUITS / FEEDERS Transfortner I Power Su fa S' ns I OuUine Li htin S5
0 to 200 Am e E5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $70 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @ S80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addition� Insoection Trios � S20
TO
3 to 12 Units � E50 Per Unit
OTHER ADDITI01
LighGng Retrofit � b.25 per Fixture
Center Pivot irtiaation Boom � S40
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TOTALFEE ��0. �O
(minimum total fee is $20)
iM5 AIiFA FOR INSPECTOR USE Mv
I hereby cerEly that I inspeched the ek�ctrical i�taNaOOn desaibed herein on Me dartes sUkd:
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aeyuesc oace: r�n�n mspea;on Ftequired� ❑ res ,�.No tr�speapn om� rnan rta,yn-in: ❑�eady Nor+� vum can
9� � 0� �s You must call the inspector when ready! Date Ready:
I certify that I am ttie �LICENSED CONTRACTOR �COMPANY 0 OWNER and hereby request inspection of the electrical xrork at: