P - 80146REQUEST FOR ELECTRICAL INSPECTION
1 3 G 1 3 1 5 �° z Minnesota Board of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�,�� e='� (651) 642-0800 TTY/MRS 1-800-627-3529
' www.eiectricity.state.mn.us
Identify the work covered by this request: � �� � � ('� _ _ �� � � j„� b�j �Ir {M� Sc:�-j
l%1' IG � ;1AS2? liic�
❑ NEW �EMODEL ❑ADDITION ❑ REPAIR
GENERAL FEES Outdoor Lightino Standard �$1
SERVICES / POWER SUPPLIES
0 to 4�a Am ere �
401 to 800 Am ere �$50
Above S00 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am re �
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALIN
CIACUITS. CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Unfts (� $50 Per Uni!
Each Addifional Unit � $25
OTHER ADDITIONAL FEES
Lighting Retrofit � $.25 per Fixture
Center Pivot Irtigation Boom � $40
Manutactured Home Park Lots � $25
Recreational Vehicle Park Sites � $5
Seuarate 8ondina Insoectio� � $20
TraHic Si nal Standard � $5
Su lemental Fee � $20
Transiormers up to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li htln �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$S(
Additional Inscection Trins � $20
FON INSPECT011 USE 0'&Y
4� �'��-Cf�-,�
FOR OFflCE USE ONLY
1111lI i{III illll NIfllliil 11if1 ilNl f1111II1i 1111
� 1 3 D 1 3� 5 6�
I insoected ihe electricai installation
total fee is
dates
'ITHIN 18 MONTHS
I certi(y that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at