P - 81571REQUEST FOR ELECTRICAL INSPECTION
'' Q Minnesota Board of Electricity —
�� 0 3 9� V� V �A � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us " '
IdentiTy the work covered by this request: �y �1w � � (�
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�fOEW ❑ REMODEL ❑ ADD�TION ❑ REPAIR
0 to 400 Ampere � $25
401 to 800 Am ere �$50
Above 800 Ampere � $75
CIRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTR(
ClRCUITS, CIRCUITS OF LESS THAN 50 VOL
Each Svstem Device or Aooaratus �$.50
3 to 12 Units �$50 Per Unit
Each Additionai Unit � $25
OTHER ADDITIOP
Ughting Retrofit � $25 per Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots
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Outdoor Li htin Standard � $1
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transtormers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transfortner I 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
Circuits and Two Inspection Trips Each Dwelling Unii �$8L
Additionai Ins ion Trips � $20
Investiaative Fee
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`'�� fminimum total fee is $20) 3b `�1
1 herebvi certitv that I insoected tl�e
Special Inspection �$.31 per Mile I I
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described herein on the
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( Request Date: I Rough-in Inspection Required? ❑ Yes ��i I Inspection Other Than Rough-In: �¢99atly Now U wm can I
1,—�a: —� You must call the inspector when ready! Date Ready:
i certiiy ihat I am the�.ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: