P - 81699_ ___ _ _
REQUEST FOR ELECTRICAL INSPECTION
.� 0 21 2 7 O Minnesota Board of Electricity
�� � �° ' ig21 University Avenue Suite S-128, Saint Paul, Minnesota 55104
' � (651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. state. mn. us
covered by this request:
I ❑NEW
❑ REPAIR
SE VICES I POWER SUPPLIES
to 400 Am ere � $25 ' ►C^
401 to 800 Am ere �$50
Above 800 Am re � $75
CIRCUITS / FEEDERS
0 to 200 Am re�$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, ClRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit f� $25
OTHER ADDITIONAL FEES
Cenier
Park Sites �
n
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transfortner / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Senrice andlor Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Tri s Each Dwelling Unit �$8(
Additional Ins ection Tri s�$20
Investi ative Fee
Reinsoection Fee � $20
.S/�� � (mir
FOP INSPECTOq USE ONLV
�����vff, � yg_�!
�S' � /S"�!� �" 3. !1_� L
I herebvi certiN that I insoecled tlie elec4rical install
� J Special Inspection �$.31 per Mile "� � `
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NC
FOR OFFlCE USE ONLY
I IIIIII IIIII IIIII I IIII IIIII I�I IIII� IIl1 IIlI �� ��9
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Request Date: Rough-in Inspection Required? es ❑ No Inspection
� ,,,7 �� You must call fhe inspec[or when readyl Date Rea�
i certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER
�
Than
total fee is $20) = Q �
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c�' t� �'� - o �
bed he n on e st�d:
� �`
Ready Now ❑ �II Call
and hereby request inspeclion of the electricai work at: