P - 79875REQUEST FOR ELECTRICAL INSPECTION
1 3� 1 19 5 �� v Minnesota Board of Electricity
� � "� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
-- � �� �oe� (651) 642-0800 TTY/M jS�00-627-3529
www.electricitv.sta��.�s " '
Identify the work covered by this request: �
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
401 to 800 Ampere � $50
Above 800 Ampere � $75
�UITS / FEEDERS
0 to 200 Ampere � $5
Above 200 Ampere � $10
RM, COMMUNICATIQN, REMQTE
CUITS, CIRCUITS OF LESS THAN
Each System Device or Apparatus
ADDITIONS TO THE (
_TIFAMILY DWELLINGS (PER UNII
3 to 12 Units �$50 Per Unit
Retrofit � $25 cer Fixture
� $30 Der Hour
/� � �
utdoor Li hti Standard � $1
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transiormers u to 10 KVA �$10
Transfortners over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Inciudes the Service and�or Power Supply up to 500 Amperes, All
Circuils and Two Inspection Trips Each Dwefling Unst �$84
Additional Ins ection Tri s�$20
Investi ative Fee
Reinsoection Fee � $20
� he�ebvi certifv that I
(minimum total fee is $2Q�:]�
296�4 �
i installaliai described herein on tl�e dates stated:
� — �Speciat 4nspection � $ 31 per Mile � � �V —�'— � —�'� �"1-
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 1S MONTHS
� � FOR OFFlCE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In. Now ❑ Wi�l Call
'` � Q You must call the inspector when readyl Date Ready:
I certify that I am the2��NSED CANTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of The eiectrical wo►k at: