P - 764072�10��516 �
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REQUEST FOR ELECTRICAL INSPECTION �=�`�
Minnesota Board of Electricit j�,� �/j�j /1,Q `�- � :�
182j�Jniw�si venue Suite S-128, Saint Paul, MinnesotaT5f1�4! ��� k �
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(�1) 6�2 jl$00 /MRS 1-800-6273529 www.electricity.state.mn.us ?ie�
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GEN L FEES
SERVICES I POWER SUPPLIES
0 to 400 Ampere $25
401 to 800 Am re $50
Above 800 Am ere $75
CIRCUITS / FEEDERS
0 to 200 Am ere $5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Ap aratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofit $.25 per Fi�ure
Center Pivot Irrigation Boom $40
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites (�D $5
Traffic Signal Standard @ $5
Supplemental Fee $20
Transformers u to 10 KVA a$10
Transformers over 10 KVA $ 20
Transformer / 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 Unit @$80
Fee
TOTAL FEE �y��
total fee is $20) va.�� �Q
that I inspected the electrical installation descnbed herein on the dates stated: �
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Date: Rou h-in Ins ection R
g p equired? ❑ Yes No Inspection Other Than Rough-In: � Ready Now Will Call
� �-1 /�/ � You must call the inspector when ready! Date Ready:
I certify that I am the pQ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: