P - 819521-102-633 �P:
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Identity the work covered by this request:
❑NEW ❑REMODEL ❑ADDITION ❑REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am ere �$25
401 to 800 Am ere �$50
Above 800 Am ere � $75
CIRCUITS ! FEEDERS
0 to 200 Am ere �$5
Above 200 Am ere � $70
ALARM, COMMUNICATION, REMOTE CONTROL, SI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus �$.50
OTHER ADDITIONAL FEES
Retrofit � $25 oer Fixture
Recreational Vehicle Park Sites
Seoarate Bondina Insoeclion �
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 Li htin Standard � $1
Traific Si nal Standard � $5
Su plemental Fee � $20
Transfortners u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / OuHine Li Min �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 500 Amperes, Ail
GNALING Circuits and Two Inspection Tri Each Dwellin Unit �$80 "
AddRional Ins 'on Tri � $20
Investi tive Fee
S Reinsoection Fee � $20
total fee is
insTellaOOn desaibed herein on the dates a�d:
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITNIN '
FOR OFFICE USE ONLY
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Reaue Date: I Rouoh-in Insoection Reauired? fl Yes No Insoection Other Than Rouah-In: eadv
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Will Call
�((J� �[ � U � � You must call the inspector when ready! � Date Ready: �
I certity that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at