P - 82016REQUEST FOR ELECTRICAL INSPECTION
� � Minnesota Board ofi Electriciry �
1���. 2�� 3� �"'� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�' �� (651) 642-0800 TTY/MRS 1-800-§2��3 529
www.electricitv.state.mn.u�� u /I `�
Identiiy the work covered by this request:
❑NEW ❑REMODEL ❑ADDITION ❑REPAIR
GENERAL FEES
SERVICES / POWER SUPPUES
0 to 400 Am ere �$25
401 to 800 Am re�$50
Above 800 Am re � $75
IRCUITS / FEEDERS
0 to 200 Ampere � $5
CIRCUITS OF LESS THAN 50 VOLTS
OTHER ADDITIONAL FEES
Retrofit � $25 oer Fixture
Recreational Vehicle Park Sites �
Separate Bonding Inspection � $2(
Special Inspection � $30 Der Hour
c
�'j G r�,�� c ,
Outdoor Li htin Standard � $1
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA (� $20
Transiormer / Power Su I for S' ns / Outline L' 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 Dwelli Unit �$8C
Additionaf Insoection Trios � $20
Fee �
(minimum total fee is
289�'�
I hetebvi certilv mat I inspected ihe electrical
FOR OFFICE USE ONLY
I ������ ����� ����� �I��� ����� ���� (���� ��I� ���� ��%� �
* � 1 a � 0 3 � o * ��r .�'� �
����`�
�7
I certi(y that I am the�'LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: