P - 80515REC�UEST FOR ELECTRICAL WSPECTION
1 16 4 O O 2 � Minnesota Board of Electricity '�
� � � 1821 Universiry Avenue Suite 5-128, Saint Paul, Minnesota 55104
c. � f�
�° (651) 642-0800 TTY/MRS 1-800-627-3529
� �; L'� � ,;�, www.electricity.state.mn.us
Identify the work cuvered by this request:
❑ NEW �REMODEL ❑ ADDITION ❑ REPAIR
� SERVICES / POWER SUPPLIES
0 to 400 Amoere � $25
Above 800 Am ere � $75
CUITS / FEEDERS
0 to 200 Am re �$5 .
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 er Fi�ure
Center Pivot Irtiaa6on Boom �$4 !1 �_
nspection � $21
� $30 oer Fbur
.� ���-Y\ �D� \-�7�%-i ��
Outdoor Li htin Standard (� $1 —�
Traffic Sianai Standard � $5
Transformers u to 10 KVA (� $10
Transformers over 10 KVA � $20
Transfortner I Power Supply for Signs / Outline Lighting �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unii �$8(
Addftionalins ection Tri s � $20
Investi ative Fee
Reinscection Fee � $20
I herebvi ceitiN that I insoected the
total fee is
an the dates sfated:
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITFIIN lg IYIVNT„5 -
FOR OFFN� USE ONLY
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� 1 1 6 4 O D 2 6� /e�'3 �" v�o�J�
Request Date: Rough-in Inspection Hequired? ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now ill Call
�'(1 / You must call tlie inspector whe� readyl Date Ready:
I certiiy that 1 am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecUon of the electrical work at: