P - 77126REQUEST FOR ELECTRICAL INSPECTION
1-� 4�=10 3�9 Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.e[ectricity.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION REPAIR Describe -usin the back of ihe white cop if necessary - the work covered by this re uest:
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0 to 400 Am ere $25 l/'�"
401 to 800 Am re S50
Above 800 Am re $75
CIRCUITS I FEEDERS
0 to 200 Am re $5
Above 2(10 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ralus $.50
ADDITIONS TO THE �ENERAL FEES
FEES
(�II I�III IIIII I�II� (IIII (IIII III�I (IIII �� I�
16471U39
Transformers u to t0 KVA $10
Transformers over 10 KVA @$ 20
Transformer I Power Supply for Signs / Outline Lightinq_ @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes lhe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspec5on Trips Each Dwelling Unit @$80
Reins tion Fee $20
TOTAL FEE
(minimum total fee is $20) •
rws naEn Foa irs�craa usE «ar
I hereby ceAily Mat I inspected the ek�ctrical installa6on described herein on the dates staled:
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Reques e: Rough�n Inspection Required? L] Yes IJ No Inspedion Other Than Rough-In: L7f2eady Nav ❑ NMI Call
fQ S You must call the inspector when ready! Date Ready:
I certify t I am the �r uCENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the electrical woric at::
Job Site Address (Street, Box, or Route No.) City Zip Code
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