P - 79668REQUEST FOR ELECTRICAL INSPECTION
1-� 1�- 7�� e�° Minnesota Board of Electricity
J ° 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 `.
(651)642-0800 TTY/MRS 1-800-627-3529
CITY www.electricity.state.mn.us '� '
�dentity tne work co�ered ny tnis request: JTP/I4 8 31 — LOST A PHASE � PANEL BLE[�l
❑NEW ❑REMODEL ❑ADDITION �3REPAIR SEE BILL OLER ONSITE.
GENERAL FEES Outdoor Liqhtinq Standard �$1
0 to 400 Am ere �$25
401 to 800 Am ere �$50
Above 800 Am ere � $75
CIRCUITS I FEEDERS
0 to 200 Am ere �$5 ° Q j-j j�
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Retrofit � $.25 per Fi�ure
Recreational Vehide Park Sftes � '
Separate Bonding Inspection � $21
Soecial Insnection � $30 oer Hour
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
�NE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$8C
Additional Inspecfion Trips � $20
Investi ative Fee
Reinsoection Fee � $20
that I inscected the electricai
total fee is
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 78 MONTHS
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes � No Inspectlon Olher Than Rough-In: ❑ Ready Now�] Will Call
3 14 0 2 You must call the inspector when ready! Date Ready:
I certity that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection ot tt�e electrical work at