P - 78725/� ;!� REQUEST FOR ELECTRICAL INSPECTION �
,�„ � `-F ,l o � :7 0 3 � Minnesota Board of Electricity - �:
� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the xrork covered by this request:
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GENERAL FEES Outdoor Liahtina Standarcl � S1
I 401 to 800 Ampere @$50
1 Above 800 Amoere � $75
CIRCUITS / FEEDERS
0 to 2(!0 Amcere p$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 FEES
Lighting Rehofit � $.25 per Fixtu2
� Center Pivot Irriaation Boom � S40
Transfortners over 10 KVA $ 20
Transformer / Power SuDdY fw Sians I OuUine Ligh6nq $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips E�h Dwelling Unit �$80
(minimum total fee is $20) I ��„s�
THIS NiEA FOR IISPECTOR USE OIlY
I hereby terfiy that I inspected the electricai insfaN�on described herein on tlie da�s st�ed:
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Request Date: � �gh-in Inspection Required? ❑ Yes , Inspedion Other Than Rough-In: y Now � Nfill Call
You must call the inspector when ready! Date Ready:
I cefiy that I am the �CICENSED CONTRACTOR 0 COMPANY ❑ OWNER and hereby request mspection of the electrical work at:
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Job Site Address (Sheet, Box, Route No.) Cily Zip Code
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Master Electridan or Power Limited Technician
Licen Number
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EB-0OOOtA-14 8.1.20D2