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Identify the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529
www. electrici ty. state. mn. us
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0 to 400 Am ere �$25
401 to S00 Am ere �$50
Above 800 Am ere (� $75
CIRCUITS / FEEDERS
Qto2�A re�$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S tem Device or A ratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per UnR
Li hHrv Retrofit �$25 er Fixlure
Center Pivot I' tion Boom �$4(
Manutactured Home Park Lots � $
Recreational Vehide Park SN�s �
Se arate Bondin 1ns 'on � $21
S ecial Ins 'on �$30 r Hour
S ial In ' n�$.31 r Mile
THIS INSTALLATION M�
Traffic Signal Standard �
SuDDlemental Fee � $20
� Transfortner / Power Supply for Signs / OuHine Lighting �$5
ONE � N!0 FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$8(
Addi6onal Ins ection Tri s�$20
Investi� ative Fee
Reinsoection Fee � $20
total fee is
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/ITHIN 18 MONTHS
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Request Date: Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-In: Ready Now ❑�II Call
��V �Q �, You must call the inspector when readyl Date Ready:
I cerMy U�at I am the ,�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Address (Street, Box, or Route No.) Ciry Zip Code
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Section Township Range Fire No. Coyqty� �
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Power Supplier Address
Electrical ConVactar / Company Name Contractor License Number Master License Number
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Mai6ng Address (Contractor, Company or Owner PeAortnjpp Insfallation) _ , __ \ _
Company or Owner Performing Install�tion) — ' � Phone
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BOARD OF ELEC7AICRY f�PY ` WSTNUCTIONS ON BACK OF