P - 78303REQUEST FOR ELECTRICAL INSPECTION
1���`�F 1- 3 5 2 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
IdemiTy the work covered by this request:
❑ NEW ❑ REMODEL p ADDITION ❑ REPAIR
GENERAL FEES
/ 0 to 400 Am ere �$25
401 to 800 Am re �$50
Above 800 Am re � $75
CIRCUITS / FEEDERS
0 to 200 Am re l� $5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES •
Li hti Retrofit �$25 er Fature
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots � $25
Recreational Vehide Park Sites � $5
S rate Bondin Ins 'on � $20
S ial In �$30 r Hour
Soecial insoection � $.31 cer Mile
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Outdoor Li htin Standard � $1 /�
Tratfic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer I Power Su for Si ns / Outline Li Min �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$8(
Addi6onal Ins edion Tri s�$20
InvestigatNe Fee
Reinsoection Fee � $20
total fee is
I insoected the electrical installafian described herein an the dates stated:
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OPFICE USE ONLY
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RequASt ate: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now Will Call
`� 2 � You must call ihe inspeclor when ready! Date Ready:
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY �WNER and hereby request inspection o( the electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
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Section Township Range Fire No. County
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Ockupant Phone
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Power Supplier Address
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Electrical Contractor Company Name Contractor License Number Master License Number
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Mailing Address (Contractor, Company or Ow,n,e,,rr Perfortning Installation) �
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Authorized Signature (Contractor, Company or Owner Performing Installation) Phone
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E&00001A-13 7/1/2000 BOAHD OF ELECTRICITY COPY INSTFIUCTIONS ON BACK OF YELLOW COPY