P - 81930REQUEST FOR ELECTRICAL INSPECTION
[ Minnesota Board of Electricity °-��
�,. � � � � � �J � � ��� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
. a � = (651) 642-0800 TTYlMRS 1-500-627-3529
yQ � i www.electricity.state.mn.us
Identify the work covered by this request: •
❑NEW ❑REMODEL ❑ADDITION REPAIR , ��� ���
GENERAL F S Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard (� $5
0 to 400 Am ere �$25 Sup lemental Fee C� $20
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Amcere �$75 Transformers over 10 KVA �$20
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE C(
CIRCUITS, G4RGUITS OF LESS THAN 5(
Each Svstem Device or Aooaratus �
Iditionai Unit � $25
OTHER ADDITIONAL FEES
Retrofit f� $25 ner Fixture
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Includes the Service andor Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$8G
Additional Inspection Trips � $20
Investiaative Fee
total fee is
FOR OFFICE USE ONI.Y
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Request Date: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now �II Call
'� �Z— V` You must call tlie inspector when readyl Date Ready: �
I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Rouie ho.) � City . Zip Code
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Sectio� Township Range Fire No. Coun
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Power Supplier
E 'cal Contractor / Company Name
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Mailina Address (Contractor. Companv or Owr�er P
Authorized SignaNre (Contractor, Company or
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