P - 81835REQUEST FOR ELECTRICAL INSPECTION
e
Minnesota Board of Electricity �
1 r 0 41 �� H� a 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
t � www electricity state.mn.us �'�
Identity the work covered by this request:
p NEW ❑ REMODEL ❑ ADDITION
GENERAL F
SERVICES / POWER SUPPLIES
0 to 400 Amoere � $25
REPAIR 1 vl--� �i 0.0 �- , � �
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unit
Each Addi6onal Unit � $25
OTHER ADDITIONAL FEES
Li hd RetrofR �$25 r Fixture
Center Pivot Irti abon Boom �$40
Manufactured Home Park Lots f� $25
Recreational Vehicle Park Sites � $5
Se arate Bondin Ins ection �$20
Snpr.ial Insoection � $30 oer Hour
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transiormer / Power Su ly for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circufts and Two inspection Trips Each Dwelling Unit �$81
Fee �
TOTAL FEE�O � I
total fee is $20
I hereby cer6fy that I inspected the electrical installation described herein on the
�8''8
FOH OFFlCE USE ONLY
IIIIIIIIIIIIIIIlIIlllllllllll�lllllllllilll a°� , •
�� 0 4 1� a z s� /�-� c�`�
Request Date: Rough-in Inspection Required7 ❑ Yes No Inspection Other Than Rough-In: Ready Now ❑ wll Call
'— oI You must call the inspector when ready! Date Ready: "" p2,` —� r
I certify that I am the �LICENSED CONTRACTOR �OMPANY ❑ OWNER and hereby request inspection of the elecUical work at