P - 82032REQUEST FOR ELECTRICAL INSPECTION
1 13 3 0 5 4 Minnesota Board of Electricity
� � � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OS00 TTY/MRS 1-800-627-3529
www. electricity.state.mn. us ' �`
Identity the work cavered by this request: '+ � � j
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❑ NEW ❑ REMODEL ❑ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard (� $1
SERVICES / POWER SUPPLIES Traific Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Amoere �$75 Transformers over 10 KVA �$20
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTROL,
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL f
.TIFAMILY DWELLINGS (PER UNI�
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Liahtina Retrofft � $25 per Fixture
Center Pivot Irrigation Boom �
Manufactured Home Park Lots
R�reational Vehi�e Park Sites
Senarate Bondina Insoection �
Transtortner / Power Su for Si ns / Outline Li htin �$5
ONE & TWO FAMIIY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Ins ection Trips Each Dweliin Unit �$8(
Additional Ins ection Tri s�$20
Investi ative Fee
Reir.soection Fee � $2�
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total fee is
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�f tlre e�ectrical i described herein on the dates s�ted:
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uest Date: Rough-in Inspection Required? Yes ❑ No Inspeclion Other Than Rough-In: ❑ Ready Now II Call
`� �` V You must call the inspector when ready! Date Ready:
I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical wo�C at