P - 78717REQUEST FOR ELECTRICAL INSPECTION
d�. Minnesota Board of Electricity
��- 2 4 2� V O O 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
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www. e lectnccty. state. mn. us
Identify the work covered by this request: �� Q g. SE R � C�
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR L�9 � N� R'l `�` F� E��'e.
ne���eei c�oc nutdnnr I inhtina Standard �$1 C"' �.
401 to S00 Am ere �$90 "
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am re �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTR(
CIRCUITS, CIRCUITS OF LESS THAN 50 VOL'
Each stem Device or raius �$.50
ADDITIONS TO THE GENERAI
to 12 Units � $50 P�
ach Additional Unit �
Retrofd � $25 per Fix
�ivot Irrigadon Boom �
tured Home Park Lots
�nal Vehide Park Sites
Standard � $5
Fee � $20
up to 10 KVA � $10
over 10 KVA � $20
Transfortner / Power Supply for Signs / Outline Lighting � 55
ONE & TWO FAMILY DWELLINGS, EACH UNR
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two InspecGon Trips Each Dwelling Unit �$8f
Fee
linsoectedthe electricalinstalla6on
total fee is $20)
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;cribed herein on the de� stated:
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__ _ _ _ FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspecfion Other Than Rough-In: Ready Now ❑�II Cal�
� � You must call Cre inspector when readyl Date Ready:
I certiiy that I am the'�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection ot the electrical work at: