P - 78299REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electriciry �
1� 3 5 7- 2 6 7 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 =
www.electricity.state.mn.us � S
Identity the work covered by this request:
❑NEW ❑REMODEL ❑ADDITION ❑REPAIR
0 to 400 Am re� a25
401 to 800 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 Und
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofft �$25 er Fixture
Center Pivot Irrigation Boom � $40 �,
Manufadured Home Park Lots � �25 .
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer I Power Su d 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 Dwelling Unft �$6(
I Additional Inscection Trios (� $20
Fee �
total fee is
I hereby cerNy ihat I inspected the electrical installa6on described herein on ihe dates
ate Bondin Ins ion � $20 "
91 In �on � $30 r Hour "�CfON � �+��
al In 'on � $.31 r Mile �7j—Z/—� �
5 INSTALLATION MAY BE ORDERED DISCONNECTE NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY �(1(-',
I III��� III�II��I� �II � � `�� �
I IIIII Illll IIIII IINI ll 1
IIIIi ��
� 1 3 5 7 2 6 7�* �
I certi(y that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and herebv reauest insnarrinn �f �tio oio,.��,.�� ,.,..�, .,..
��w � nu� i tins VN eACK OF YELLOW COPY