P - 81817REQUEST FOR ELECTRICAL INSPECTION
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Minnesota Board of Electriciry �`°
_l �/�- O 2� 9 7 8 �"��° 1821 University Amenue Suite S-128, Saint Paul, Minnesota 55104
Jr� (651) 642-0800 TTY/MRS 1-800-627-3529
� � � � www.electricity.state.mn.us "
Identify the work covered by this requesi:
❑ NEW EMODEL ❑ ADDITION ❑ REPAIR I�JS �' ����� (� �
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Ampere �$50 � Transformers u to 10 KVA �$10
Above 800 Ampere � $75
�UITS / FEEDERS
0 to 200 Ampere (� $5
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTROL; SIG
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
.TIFAMILY DWELLINGS (PER UNI�
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Center Pivot
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 and/or Power Supply up to 500 Amperes, Ali
Circuits and Two Inspection Trips Each Dwelling Unit �$6(
Additional Ins ection Tri s�$20
Investi ative Fee
Reinsoection Fee � $20
Manufactured Home Park Lots �$25 "' I he ceni
Recrea6onal Vehicle Park Sites � $5 `�' �'
Se rate Bondi In 'on � $20
S ial Ins 'on �$30 r Hour """'�"01
S'al In ion �$.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTI
FOR OFFlCE USE ONIY
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total fee is
ihat I insoected the electrical installa6on described herein on the dates st�ed: �
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NOT COMPLETED WITHIN 18 MONTHS
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Request Date: Rough-in Inspection Required? ❑ Yes o Inspection Otlier Than Rough-In: ❑ Ready Now wll Call
You must call the inspector when ready! Date Ready:
I certify that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at