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NEW ❑ REMODEL ❑ ADDITION ❑ I
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GENERALFEES
REQUEST FOR ELECTRICAL INSPECTION -
Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-OSOOITY/MRS 1-800-627-3529 www.electricity.state.mn.us
� Descnbe -usin�the back of the white copy if necessary - the work covered by ihis request:
ALARM, COMMUNICATION, REMOTE CONTROL, SIG'
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNiT
3 to 12 Units @$50 Per Unit
Each Additionai Unit @ $25
OTHER ADDITIONAL FEES
Li htin Retrofit $.25 er Fixture
Center Pivot Irri ation Boom $40
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites $5
Se arate Bondin Ins tion $20
Scecial InscecGon (a� $30 Der Hour
outdoor
Traffic S
Fee @ $20
up to 10 KVA @ $10
over tO KVA Cd $ 20
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
TOTALFEE I
(minimum totai fee is $20) 20.50
THIS AREA FOR IfLSPEGiGR USE p1Y
I hereby ceNfy that 1 inspected tlie electrical installation descnbed herein on Me dates staled:
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS _ �
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Request Dffie: Roughin Inspectio� Raquired't ❑ Y� Iruupection Other Than Rough-In: ❑ y Now � Will Call
�7��� You must call the inspector when ready! Da�e Ready.
I certify thai I am the �ICENSED CONTRACTOR ❑ CON�ANY ❑ OWNER and hereby request inspection of U�e electrical work at:
INS7RUCTONS ON BAGK OF YELLOW COP1' BOARD OF EIECTRICRY COPY EB-00001A-14 B.i. 2002