P - 77016REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electriciry �
�� 3 4 7- 5 41 �82� University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us ,,(���— .,� �..,, ,-�_
❑ NEW ❑ REMODEL ❑ ADDITION � EPp
GENERAL F S
SERVICES / POWER SUPPLIES
0 to 400 Am ere �$25
401 to 800 Am re �$50
Above 800 Am re � $75
CIRCUITS / FEEDERS
0 to 200 Am re�$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or aratus �$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLIN�S PER UNI
3 to 12 Unfts �$50 Per Unit
Each Additional Unit � $25
OTHEfi ADDITIONAL FEES
Li htin Retrofit �$25 r Fixture
Center PNot I' tion Boom �$40
Manufactured Home Park Lots � $25
� $30 oer Hour
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Outdoor Li htin Standard � $1
Traffic Si nal Standard � $5 '
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transtortners over 10 KVA � $20
Transformer / Power Su fw Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dweliing Unit �$8(
Additional Ins ion Tri s�$20
Investiaative Fee
total fee is $20) Ic�3/-
I herebvi cerGN mat I inspected the electrical installatlon described herein on the dates stated: I
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FOR OFFICE USE ONLY
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Request Date: � Rough-in Inspection Required? ❑ Yes o Inspection Other Tha � Rough- :`Ql Ready Now ❑ Will Catl
�'� :�7 ' �% QS You must call the inspector when ready! Date Ready:
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I cert'rfy that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) Ciy Zip Code
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Power Supplier Address
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Mailing Address (Contrador, any or Ow�r Performing Installation)
Authorized naNre ontractor, C er Performing Installatian)
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INSTRUC710NS ON BACK OF YELLOW COPY