P - 80111REQUEST FOR ELECTR{CAL IIVSPECTION
1. 3 3 2 17 3 Minnesota Board of Electricity
� � P 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-35��
www.electricity.state.mn.us " '
Identiiy the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR ,�� . � �
0 to 4�U Ampere � $25
401 to 800 Ampere � $50
Above 800 Ampere � $75
�UITS / FEEDERS
0 to 200 Ampere � $5
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTROL,
CUITS. CIRCUITS OF LESS THAN 50 VOLTS
FAMILY DWELLINGS (PER UNI�
to 12 Units �$50 Per Unit
�ch Additional Unit (� $25
OTHER ADDITIONAL FEES
3hting Retro�t � $25 per Fixture
;nter Pivot Irrigation Boom � $40
anufactured Home Park Lots � $25
;creational Vehide Park Sites � $5
:parate Bonding Inspection � $2U
Transformers u to 10 KVA �$10
Transiortners over 10 KVA � $20
Transformer / Power Supply for Signs / Outline LighGng �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection 7rips Each Dwellin Unit �$8(
Additional Insoection Trios � $20
Fee
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re6vi certifv that I insoecled ihe elechical
total fee is
dates sl8ted:
l I�pecial Inspec6on (� $30 Der Fbu.� �Q„1�,Z• F-' i � � 7_°� �
� Special Inspection �$ 31 per N�e V V
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
� FOR OFFICE USE ONLY
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Request Date: Rouglrin Inspection Required? ❑ Yes ❑ No fnspection Olher Than Rough- Now � Wdt Catl
'� You musl call the inspector when readyl Date Ready:
I certi(y that I am the�1C�SED CONT�TOR ❑ COMPANY ❑ OWNER and hereby request inspec6on of the electrica! work ah
Job Address (SUeet, Box, or Route N� � � � C � � � Z�P � � �
Power Suppliar
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Authorized
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Master License
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