P - 79647�
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Identify the work covered by this request:
❑ NEW REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
0 to 400 Ampere �
401 to 800 Ampere
Above 800 Ampere
�UITS / FEEDERS
0 to 200 Amcere �
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul Minnesot�5104
(651) 642-0800 TTY/MRS 1-800-627-3529 -�
www.electricity.state.mn.us ��1� '' '
!�� l.fd �` '�� L r �$ O �J
Outdoor Liahtina Standard � $1
CIRCUITS OF LESS THAN 50 VOLTS
ystem Device or Apparatus � $.50
ADDITIONS TO THE GENERAL FEES
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Lighting Retrotit � $25 per Fature
Center Pivot Irrigation Boom � $40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites � $5
Seoarate Bondina insoection � $20
Transfortners up to 10 KVA C�
Transformers over 10 KVA �
� Transformer / Power Supply for Signs I Outline Lighting �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Ins ection Trips Each Dwellin Unit @$8(
Additional Ins ection Tri s�$20
Investi ative Fee
Reinspection Fee � $20
total fee is
Ne elec�hical ir�stalla6on described I�rein on the
5 eaai ins ecnon � �u raur _ ••_ _.._- �, ���
Special lnspec6on �$ 31 per M�e �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFlCE USE ONLY
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Request Date� Rough-in inspection Required? ❑ Yes No Inspec0ion Other Than Rough-In: ❑ Ready N wll Call
�o � You must call the inspector when readyl Date Ready:
I cert'rfy that I am the LICENSED CONTRACTOR ❑-COMPANY ❑ OWNER and hereby request inspection of the electrical work at: