P - 81893REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electriciry �
1.w O 7 7� q, 8 1 "� �"� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
mm �
. (651) 642-0800 TTY/MRS 1-800-627-3529
www. el ectricity. state. mn. us
Identify the work coveretl by this request /� //�Vj��� i. /�„�y� �/Cy
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,� NEW � REMODEL ❑ADDITION� � REPAIR __
0 to 400 Am ere �$25
401 to 800 Am ere �$50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am re �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each stem Device or aratus �$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Uniis �$50 Per Unit
Lighting Retroffi � $.25 per Fixture
Center Pivot Irrigation Boom � $4C
Manufactured Home Park Lots � $
Recreational Vehicle Park Sites �
Seoarate Bondina Insoection � $21
t
Traffic Si9nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA C� $20
Transformer / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$B(
total fee is
on tlie dates
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Reqy�S�t@ Rough-in Inspection Required? ❑ Yes o InspecNon Other Than Rough-In: eady Now � WIH Call
� �J r V/ You must call the inspector when readyl Date Ready:
I certify that I am the�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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Section Township r�e� � Fire No. County
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Authori Sign re ( actor, C y or Owner Performing Installation) /�
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Eg.ppppl 7/pppp BOARD OF ELECTRICRY COPY
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INSTpUC710NS ON BACK OF VELLOW COPY