P - 78423. REQUEST FOR ELECTRICAL INSPECTION
`� - 3 6 2�� J 0 �;° �- Minnesota Board of Electricity
�e:
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529
www. electrici ty. state. mn. us
Identify the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION , �AEPAIR `� � J �
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am re �$25
401 to 600 Am re�$50
Above 800 Am re � $75
CIRCUITS / FEEDERS
0 to 200 Am re �$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S em Device or ratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per UnA
Each Additional Unit � $25
Li�hting Retrofit � $25 per Fixture
Center Pivot Irrigation Boom � $4(
Manufadured Home Park Lots � $
Recreational Vehide Park Si[es �
iey
bna Standard �
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Supply for Signs / Outline LigMing A$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 500 Amperes, All
Circuits and Two In 'on Tri s Each Dwellin Unit �$8C
Additional Inspection Trips � $20
Investiqative Fee
total fee is
I inspected tl�e electrical insfallation descr�bed he2in on Ihe dat� �d:
3p�ial Inspection �$.3t per Mile �-- �° Z"p ff� I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFlCE USE ONLY
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( Re�Date: � I Rough-in InspecUOn Requiretl7 ❑ Yes ❑ No I Inspection O[her Than Rough-In: �J. Ready Now �J �tl Call I
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You must call Uie inspector when ready! Date Ready:
I certity that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electricai arork at: