P - 78310REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electriciry '�
�� 3 4 7- 3 6 9 �82� University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 =
www. electricity. state. mn. us
Itlem�iy the work covered by this request:
❑ NEW 1�REMODEL ❑ADDITION ❑ REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am ere �$25
401 to 600 Ampere � $50
Above 800 Ampere � $75
CIRCUITS / FEEDERS
0 to 200 Ampere � $5
Above 200 Ampere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additlonal Unit � $25
OTHER ADDITIONAL FEES
Li hc�fing Retrofd �$25 per Fixture
Center Pivot Irri ation Boom f� $40
Manufactured Home Park Lots �$25 i
Recreational Vehide Park Sites � $5
Se arate Bondin Ins 'on � $20
S ial Ins ection �$30 r Hour
Scecial Insoection � $.31 oer Mile
_ THIS
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Su demental 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 andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin UnR �$8C
Additional Ins ection Tri s�$20
Investi ative Fee
Reinsoection Fee � $20
IF
total fee is
described herein on the dates stated:
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_ WITHIN 18 MONTHS
FOR OFFICE USE ONLY �� 6�3
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Request Date: Rough-in Inspection Required? Yes No Ins
�/ � ❑ pection Other Than Rough-In: ❑ Ready Now Will Call
���� N' � / You must call the inspector when ready! Date Rea :
dY
I certity that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY
� OWNER and herebv renuoct incn�e��„ n4 fhe ��,.,...:,.,,� ..._�. _..
�NSiHUCTIONS ON BACK OF YELLOW COPV