P - 81703�-�-�- '-"
1-OFO-573 �:_
Ide�tify the work covere y this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity —
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-0800 TfY/MRS 1-800-627-3529
www.electricity.state.mn.us • , ,
Above 800 Am ere �$75 �
CIRCUITS / FEEOERS
0 to 200 Am re �$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem'Device or Aooaratus � $.50
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL
Liahtina Retrofit � $.25 oer Fixture
� $30 per Hour
7raffic 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
Inciudes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelfing Unit �$8(
Additional Inspection Trips � $20
�
FOR OFFICE USE ONLY
illllllllllllllllllll111IIII�IIIIIIIIIIIIN� � 83y
� i o6os�� �. � a4,�d
Requesl Date: Rough-in Inspection Required? ❑ Yes
Other Than
total fee is
inslallaUOn described
•
� 3-Z '�( �
WITHIN 18 MONTHS
�.. �a3"O' You must call the inspec[or when ready! Date Ready: �
.I certify that I am the ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical arork at