P - 78957REQUEST FOR ELECTRICAL INSPECTION
1� 6 5.4 - 6 9 9❑6 Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
, (651) 642-08Q0 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION ❑�EPAIR Descnbe using the back of the whttacopr if n�cess8ry -,�he wq�,covered by this request:
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GENERAL FEES'� ' � Outdoor Liahtina Standard (� S1
SERVICES / POWER SUPPLIES
0 to 400 Am ere $25
401 to 800 Am ere $50
Above 800 Am re $75
CIRCUITS I FEEDERS
0 to 200 Ampere @ $5
Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEE;
Lighting Rehofit @ $.25 per Fixture
Center Pivot Imaation Boom � $40
Fee @ $20
�D to 10 KVA na $10
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
Fee
(minimum total fee is $20) � ,�;_:�� % `� .`�
iHISAREAFIXtINSPECi ONLY
I hereby cer6y that I inspected the elec6ical installation described herein on the dates spBed:
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Req�t�e: Rwgh-in Inspection Required? ❑ Yes Inspedion OtMer Than Rpigh-In: y Now ❑ VWI Cell
� You must call tl�e inspector wh� readyl pete Rp,ady
I certify that I am the C,yCfBEHSED CONTRACTOR ❑ COA�ANY ❑ OWNER and hereby request mspection of the electrical work at:
EB-OOOOtA-14 8.1.2002