P - 774361-347-531
Identi(y the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity �/7b�— �n�
1821 University Avenue Suite S-128, S� nftisaul, innesota � 4
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electri ci ty. state. mn. us
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0 to 400 Am ere Q,f29' = 077 '�
401 to 800 Am re�$50
Above 800 Am re � $75
CIRCUITS / FEEDERS
0 to 200 Am re�$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Addftional Unit � $25
OTHER ADDITIONAL FEES
Li hti Retrofit �$25 r Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots � $25
Recreztional Vehicle Park Sites � $5
nspecGon � $.31 per Mile
INSTALLATION MAY
Tratfic Signal Standard � $5
Supplemental Fee � $20
Transformers up to 10 KVA �$10
Transformers over 10 KVA � $20
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unft �$80
Additional Inspection Trips (� $20
Investiaative Fee
that I insoected the electrical inslallation
total fee is
WITHIN
�
FOR OFFICE USE ONLY
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Reques�e: Rough-in Inspection Required? Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now Will Call
� You must call the inspector when readyt Date Ready:
I certity that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY � OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
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Section Townshi� Range Fire No. County
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Occupant Phone
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Pawer Supplier Address
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Electrical Contractor / ny Name Contractor License Number Master License Number
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Mailing Address ( a mpany or Owner Perfortning Installation)
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Autho 'zed $ignature (Contractor, Company or ner Perfortning Installation) Phone
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EB-00001A-13 7/2000 BOARD OF ELECTRICRY COPY INS7RUCilONS ON BACK OF YELLOW COPY