P - 81855REQUEST FOR ELECTRICAL INSPECTION
�� Minnesota Board of E{ectricity
1-575-414 $ 1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104
P (651) 642-OB00 TTY/MRS 1-500-627-3529
www. electriciry. state. mn. us
IdentiTy the work covered by this request
O�LIEW CI REMODEL ❑ ADDITION ❑ REPAIR it�EL EhIERGY SAVER�.�i SWITCH
GENERAL FEES Outdoor Liqhtinp Standard �$1
401 to 800 Am ere �$5�
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am ere � $10
AIJ�RM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or aratus �$.50
ADDITIONS TO TNE GENERAL FEES
12
Lighting Retrofit �
Center Pivot Irriaal
to
�
, ,�:w.
�l:
,�.,.
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspedion Trips Each Dwelling Unit (� $80
Additional Inspection Trips � $20
investigative Fee
Reinspection Fee � $20
TOTAL FEE
(minimum total fee is $20)
FOfl INSPECTOR USE ONLY .
ROUGH IN
FlNAL INSPECTIIXJ
oaTE
OATE
S�ZZ�
FOR OfFICE USE ONLY
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Hequest Date: Rough-in Inspection Required? ❑ Yes ❑ Inspection Other Than Rough-in: eady Now ❑ Will Call
ig '� You must call the inspector when ready! Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: