P - 81578REG�UEST FOR ELECTRICAL INSPECTION
�� � � � � � „� , Minnesota Board of Electricity
�� � � tl 1821 University Avenue Suite S-12$ Saint Paul, Minnesota 55104
� " (851) 642-0800 TTY/MRS 1-800-627-3529
�` www.electricity.state.mn.us
Itlentify the work covered by this request: /L jf� p� ��j ��, � U1 Fi' p�( �'� /,J Q'�= ii ��� y� �
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❑ NEW ❑ REMODEL ❑ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 t 0 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li hGn �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Suppty up to 500 Amperes, All
AIARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Tri s Each Dwellin Unit (� $80
CIRCUlTS, ClRCUITS OF LESS THAN 50 VOLTS Additiona! In ion Tri s�$20
Each S stem Device or ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$50 Per Unit (minimum total fee is $20) ��
EaCh Additio�al Unit �$25 wn ir+se�cTOR use ori�v
Manufactured Home Park Lots
Recreational Vehicle Park Sfte;
� $.31 oer Mile
I herebvi certifv that I insoecled the electrical
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Requgst ate: Rough-in Inspection Required? ❑ Yes No Inspection O[her Than Rough-In: eady Now ❑ Will Call ��
'� Lf� � You must call the inspector when readyl Date Ready: 1 Z
I certi(y that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe electrical wak at:
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BOARD OF ELECTAICRY COPY � 1NSTAUCTIOWS ON BACK OF YELLOW COPY