P - 796101-240-868 �6���
� � �'l�i�,3 ae���
identify the work covered by this request:
❑ NEW �EMODEL ❑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 re �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A ratus �$.50
ADDITIONS TO THE GENERAL FEE
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units (� $50 Per Unit
Each A�iitional Unit � $25
OTHER ADDITIO�
Lighting Retrofit � $25 per Fixture
Center Pivot Irri atlon Boom �$4(
Manufaccured Home Pazk Lots �
Recreational Vehicle Park Sites �
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity "�
1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104 �
(651) 642-0800 TTY/MRS 1-500-627-3529
www.electricity.state.mn.us ��\
0
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA @$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$8C
Additional Inspection Trips (� $20
{nvestiaative Fee
t herebV certiN that I inspected the elecUical
I � Special Inspection �$.31 per Mile � I C �--
THIS INSTALLATION MAY BE ORDERED DISCONNECTED I1Fii0'f COMI
FOR OFFICE USE ONLY
i fi���3 ����� 1���� ��i�� ����� i�i�� ���f� ����� 1��� ����
� 1 2 4 0 S 6 6 B�E
Req�D te: 0� Rough-in Inspectio� Required? ❑ Yes No Inspection Other Than
� � You must call the inspector when ready! Date Ready:
nimum total fee is $20� `'�'
Ilatlon desc�bed herein on ihe dates stated_
on�
oa�
r- 6 ^
'ED WITHIN 18 MONTHS
����� —
�� �� �� �
1 certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of tl�e eledricaf work at: