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REQUEST FO�F�'ELECTRICAL INSPECTION
Minnesota Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 �;
www.electricity.state.mn.us " '
IdentiTy the work covered by this request: � ,_ _ t, �► , _
❑ NEW ❑ REMODEL ❑ ADDITION REPAIR
GENERAL F S
SERVICES / POWER SUPPLIES
0 to 400 Am ere (� $25 6!�
401 to 800 Am ere (� $50
Above 800 Am ere � $75
IRCUITS / FEEDERS
0 to 200 Am re �$5
Above 200 Am re � $10
ALARM, COMMUNICATfON, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Addi6onal Unit l� $25
FEES
Recreational Vehicle
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Outdoor Li htin Standard � $1
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two lnspection Trips Each Dwellin Unit �$81
Additional Inspection Trips � $20
Investiaative Fee
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total fee is
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Request Date: Rough-in Inspeclion Required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now Will Call
�, �` You must call tfie inspector when ready! Date Ready:
I ceAity thal I am the�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
J Address (Street, Box, or Ro e No.) Ciry �P �1e
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Section Township Range Fire No. County
Power Supp er
rical Canhactor / Company Name
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BOAAD OF ELECTHICIT/ COPY INSTNUC710NS ON BACK OF YELLOW COPY