P - 79906REQUEST FOR ELECTRICAL INSPECTION
�� � � � � 0 °� �P Minnesota Board of Electricity -
E � � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� � (651) 642-0800 TTYIMRS 1-800-627-3529
www.electricity.state.mn.us " '
Identity the work covered by this request: r� S L_ �' I d� a yn �O e� ,� p
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NEW ❑REMODEL ❑ADDITION ❑REPAIR
GENERAL FEES Outdoor L' hti Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 806 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Ampere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
CIRCUITS OF LESS THAN 50 VOLTS
MULTIFAMILY DWELLINGS (PER UNI'n
3 to 12 Unfts �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Manufactured Home Park Lots �
� $30 oer Hour
Includes the Service andlor Power Supply up to 500 Amperes, All
CircuRs and Two Inspection Trips Each Dwellin Unit �$8(
Additional Inspection Trips � $20
Investiaative Fee
I
total fee is
S fNSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18
FOR OFFlCE USE ONLY
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I certiiy that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route NoJ City Zp Code
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Occupant I -
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Power Supplier
Electrical Contractor / Company Name
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Mailing ,
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Phone
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Co actor License Number Mast License umber
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Company or Owner Performing Installation)
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do o ny or er Performing Installation) Phonet �r ��� ��
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BOARD�OF ELEC7AICRY COPY INS7AUC710NS ON BACK OF YELLOW COPY