P - 81716� REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electriciry °�
����3 8���� ��� a 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
" www.electricity.state.mn.us
Identiiy the work covered 6y this request:
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR � f f � /� �U(� CL/�1 ���N � �� f� �
GENERAL FEES Outdoor Li tin Standard (� $1
401 to 800 Am ere �$50
Above 800 Am ere f� $75
CIRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S tem Device or aretus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Cent6r Pivot Irrigation Boom � $4
Manufactured Home Park Lots �
Recrea6onal Vehicle Park Sites �
� $.31 per Mile
Traffic Si nal Standard � $5
Sup lemental Fee � $2�
Transformers up to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer I Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andfor Power Supply up to 500 Amperes, All
Circuits and iwo inspection Trips Each Dwelling Unit �$St
Additional Inspection Trips � $20
� Investiaative Fee
FOIIINSPECTOR
total fee is
installation descr�ed herein on the d�es sleted:
FOR OFFICE iJ� ONLY �
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Request Date: RougMin Inspection Required? ❑ Yes o Inspection Other Than RougMln: ❑ Ready Now Will Call
�'�� 7�V / You must call tlie inspector when readyf Date Ready:
I certity that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe electrical wak at
Job Address Street, Bo or F e No.) City ZP �
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x�om�y Nam � Contradar License Number
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ntrador, Company Owner erfortning Instella'
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BOARD OF ELEC7RICRY COPY
Master License
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INS'TAUCTIONB ON BACK OF YELLOW COPY