P - 77322REQUEST FOR ELECTRICAL INSPECTION
1���'�.J `� 3 5 3� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Sairrt Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION EPAIR�„�D cribe -using the back of Me white copy if necessary - the work covered by this request:
GENERALFEES
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL
MULTIFAMILY DWELLIN�S PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEE;
Li h6n Retrofit $.25 er Fixtu2
Center Pivot Irri ation Boom ;40
Manufactured Hame Park Lots S25
Recreational Vehicte Park Sites SS
Se arate Bondin Ins tion $20
S ial Ins fion $30 r Hour
S ial Ins 6on S•31 r Mile
THIS INSTALLATION MAY BE ORI
Iliil II�!! �III� �IIII Il�� IIIII Ilill illll �� I�i
17304353
Su demental Fee � $20
Transfortners u to 10 KVA a$10
Transfortners over 10 KVA (d $ 20
Transfortner / Power Su I for Si ns / Outline Li htln $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Investi ative Fee
Reins tion Fee $20
TOTAL FEE , �
(minimum total fee is $20)
THIS AREA FOR IISPECiOR USE 0�8Y
I hereby cer6fy that I inspected tlie elettrical install�on described herein on ihe dates sfaled:
12
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K��Rough-in Inspection Required? LJ Yes � Inspection Other Than Rough-In: �ady Now ❑ Will Call
3 ou must call the inspeclor when ready! Date Ready: ��j -����
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I certify that I am the �LICENSED CONTRACTOR �ZOMPANY ❑ OWNER and hereby request inspection of ihe electrical work at: