P - 79929'�» REQUEST FOR ELECTRICA� INSPECTION
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Minnesota Board of Electricity
1-�96-i si � 1821 University Avenue Suite S-128, Saint Paui, Minnesota 55104 ��`
(651) 642-080Q TTYIMRS 1-860-627-3529
www, electricity. state. mn. us
Iidentify the work covered by this requesi;
❑`NEW Q REMODEL 0 ADDITION
D to 200 Am ere �$5 �
Above 20� Am ere � $10
ALARM, GOMMUWCATION, REMOTE CONTROI, SIGNAUNG
CIRCUITS. CIRCUITS OF LESS TNAN 50 VOITS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELUNGS (PER UNIT)
3 to 12 Units �$SO Per Unit
Each Additionai Unit � $25
OTHER ADDITIpNAt FEES
li hting Retrofii �$.25 per Fxture t
Center Pivot irri ation Boom �$40 �
Manufactured Home Park Lots � $25
Recreational Vehicie Park Sites C� $5
Hour
X�EL ENER�3Y SAVER'S SWITCH
Transformers u to 10 KdA �$1Q
Transformers over 10 KVA � $20
Transtormers ! Power Suppiy for Sipns t 0utiine Lighting �$5
ONE & TWO FAMILY DWELLINGS, EAGH UNIT
Indudes the Service and(or Power Supply up to 500 Amperes, AII
Circuits antl Two Inspection Trips Each Dwelling Unit �$SO
Additionai Inspection Trips � $20
Inves6qative Fee ______.__
Reinspection Fee � $2(1
TQTAL FEE
(minimum totai fee is $20)
FOR INSPC..^TOR ti$� ONLY
I hereby certify Ehat I inepected the electrical insfallatlon tlesenbed herein on the dates statetl:
aoucniN °ATE
�NSPFCTION OhTE
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FOR OFPICE USE ONLY
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Reque�8��2 Rough-in Inspection Required? ❑ Yes C�NO inspection Other Than Rough-in: �Reatly Now � Wil� Call
You must cali the inspector when ready! Date Reatly:
i certify that I am the L� LIGENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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