P - 786801-371-184 �s� :
Identify the work covered by this request: �
❑NEW ❑REMODEL ❑ADDITION EPA
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am ere �$25
4ot to 800 Am re �$50
Above 800 Am re � $75
CIRCUITS / FEEDERS
0 to 200 Am re�$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A ratus �$.50
ADDITIONS TO THE GENERAL f
Each Addftbnal Unit � $25
OTHER ADDITIO�
Liahtirm Retrofit � $25 oer Fature
Recreational Vehicle
� $21
Hour
REQUEST FOR ELECTRICAL INSPECTION ,_
Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn. us
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Outdoor Liahtinu Standard � $1
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Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transfortners over 10 KVA � $20
Transformer / Power Su for ' ns / Outline L' hli � S5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Tri s Each Dwellin Unft �$8(
Additional Inspection Trips � $20
Investiaative Fee _.
that I
m total fee is $20) � 3�
described herein on tl�e dates slate
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WITHIN 18 MONTHS
FOR OFRCE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now ill Catl
� 30` �� You must call the inspector when ready! Date Ready: �� 63
I certity tl�at I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: