P - 80132REQUEST FOR ELECTRICAL INSPECTION
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�" 3 3 2 141 � Minnesota Board of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OB00 TTY/MRS 1-800-627-3528
www.electricity.state.mn.us "0°�'
IdentiTy the work covered by this request:
❑ NEW ❑ FiEMODEL ❑ ADDITION ❑ REPAIR .
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Amoere �$75 Transformers over 10 KVA �$20
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or aratus �$.50
ADDITIONS TO THE GENERAL f
MULTIFAMILY DWEIIINGS PER UNI
3 to 12 Units �$50 Per Unit
EaCh Additional Unit � $25
OTHER ADDITIONAL FEES
li hti Retro�t �$25 r Fixture
Center Pivot I' ation Boom �$40
Manufactured Home Park lots � $2
ReCreational Vehicle Park Sites �
S rate Bondin Ins ion �$20
Soecial Insoection � $30 oer Hour
Transformer / Power Su I for Si ns / Outline Li htin �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Indudes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Addifional Ins ectbn Tri s�$20
Invessti ative Fee
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Reins ion Fee � $20
TOTAL FEE
(minimum total fee is $20) , �
fOfl INSPECTOH USE ONLV �
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Request Date: Rough-in Inspection Required? [] Yes ❑ No Inspection Other Than Rough : Ready Now ��II Call
� f! �� You must call the inspector when ready! . Date Ready:
I c�ltity that I am the�16ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Addre� treet, Box, or Route No.) City � Zip Code
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Section Township Range Fre No. Co
Occupant /� � � ^ Phone
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, C�oef�a�COwner Perfortning Installation)
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or, Company or Oynst Performing Installa�
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Contractor License Number Master License
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