P - 78261/�c REQUEST FOR ELECTRICAL INSPECTION
1��t V 0- 8 6 3�2 Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state
D N W ❑/ REMODEL 0 ADDITION ' REPAIR Describe -usin the bxk of the white copy'rf necessary - the work covered b
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SERVICES I POWER SUPPLIES
0 to 400 Am ere E25
401 to 800 Ampere � $50
Above 800 Am re $75
GRCUITS / FEEDERS
0 to 200 Am e$5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Exh S stem Device or aratus $.50
ADDITIONS TO THE GENERAL
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Addi6onai Unit @ $25
OTHER ADDITIONAL FEE:
htin Retrofit $.25 er Fixture
Center Pivot Irrigation Boom p$4U
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� Transfortners up to 10 KVA @$10
� Tr�sformers over 10 KVA �$ 20
Trarisfamer I Power SuDPIy for Sians I OuUine Lightinq _$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Txro Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
Investiaative Fee
(minimum total fee is $20) I �j�,� S� I
TMS �REA FOR IIbPECTIXI U5E 01�LY
I hereby certify thffi I inspecled the ek�ctrical installa6on described herein on the dates sfaled:
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�NSTA�LATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS �
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�e� Rough-in Inspection Required? ❑ Yes Inspedion Other Than Rough-In: ❑Ready Now�`Wi11 Call
You must call the inspecta when ready! Date Ready:
hat I am the�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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