P - 81936� REQUEST FOR ELECTRICAL {NSPECTION
�'� 0 9 7- 9 8 6 � Minnesota Board of Electricity -
��,� 1821 University Avenue Suite 5-126, Saint Paul� Minnesota 55104
erq��"�� (651) 642-0800 TTY/MRS 1-800-627-3529
www. electrici ry. state. mn. us
Identiiy the work covered by this request:
❑ NEW ❑ REMODEL ❑ADDITION I�REPAIR
0 to 400 Ampere � $;
401 to 800 Amoere �
0 to 200 Ampere �
CIRCUITS, CiRCUITS OF LESS TFiAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS 70 THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unft
Lighting Retrofit � $25 per Fixture
Center Pivot Irrigation Boom (� $40
Manuiactured Home Park Lots � $
Traffic Signal Standard
Su�o�emental Fee � 9
Transformers u to 10 KVA Q$10
Transformers over 10 KVA � $20
Transformer / Power Supply for Signs / OuHine Lighting �$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
Additional Inspection Trips (� $2D
Investigative Fee
Reinscection Fee � $20
I nerebvi certifv that I
total fee is
on
S cial In ion �$30 er Hour `°" "�"'°" /'�� ��"" �
S ecial Ins ection �$.31 er Mile [ �"'�' ' o
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
WR OFFICE USE OMIY
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uest Datg: ' Rough-in Inspectfon Required? ❑ Ves No Inspection Other Than Rough-In: Ready Now � Will Call
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����O You must call Me inspectw when readyl Dete Ready:
I certify that I am th LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe electrical work at
Job Address (Street, Box, or Rou[e No.) � Zip Code
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� power Supplier
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tor, Company or Owner PeAorming Installation) Phone
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BOARD OF ELECTHICRY COPV Ci31AUC7WN3 ON BAqC OF YFILOW