P - 760231 7 8 7 0 4 2 g❑ REQUEST FOR ELECTRICAL INSPECTION
� � Minnesota Board of Electriciry '� ;
r 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
-using the back of the vdhite copy'rf ne���ne ��c�y���t; S SW T TChf
GENERALFEES
SERVICES I 90WER SUPPLIES
0 to 400 Ampere � �25
ao� ro soo am re$�o
�Ve 800 $75
CIRCUIiS I FE�DERS
0 to 200 $5
�Above 200 Am re $10
, COMMllIdICATION, REMOTE CONTROL,
CIACl11TS, CIRCUITS OF LESS THAN 50 VOLTS
EaeFiSy�tem Davice or Apparatus @ $.50
ADDITIQNS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNI
3 to 1 Units @$50 Per Unft
�ach.Addibonel Unft @ $25
OTHER ADDITIONAL FEES
g Retrofit (� $.25 per Fi�ure
Cente� Pidot Irri ation Boom @$40
MaRUFadured Home Park Lats $25
Re�eational Vehide Park Sites �5
Bondin Ins 'on $20
Inspection @ $30 r Hour
'� ln ion $.31 per Mile
7Hj� 11►�$TALLATIOFI dAAY BE OR�
IIII��UI�i� illll�l� d81IIIII III� �III IIIII
17870429
Outdoor
Supplemental Fee @ y
Transfortners up to 10
Transformers over 10 I
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unft @$80
Additional Ins ction Tri $20
Investigative Fee
Reins ction Fee @ $20
TOTAL FEE e: a..
(minimum total fee is $20)
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I hereby certify thffi I inspected the electrical i�stallation d�scribed hereln on the dates stat�:
IF NOT COMPLETED
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�' Rough-in Inspection Required? ❑ Ye � No Inspection Other Than Rough-In: [�Fteady Now 0 WIII Call
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You must call the inspector when readyl Date Ready:
I�rtiiy �at I am the 'L�i LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at