P - 82030REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity " `
�„ — O 8 6� 7 7 3 "� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
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www.electricity.state.mn„ars�'' ''�'
Identify the work covered by this request:
❑NEW REMODEL ❑ADDITION ❑REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am ere �$25
401 to 800 Am re �$50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
� to 200 A re �$5
Above 200 Am re � $10
ALARM. COMMUNICATION. REMOTE CONTROL. SIGNALING
Device or Apparatus �
Lighting Retrofit � $25 per Fixtu
Center Pivot Irrigation Boom � $
Manutactured Home Park Lots �
� $30 oer Hour
G ���,�1! �
Outdoor Liohtina Standard (� $'
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Supply for Signs / Outline LighGng �$5
ONE & TWO fAMILY DWELLINGS, EACN UNIT
Includes the Service and�or Power Supply up to 500 Amperes, All
Circuits and Two Ins ection Trips Each Dwelling Unit �$8(
Additional Insoection Trios � $20
I herebvi cerlifv that I
Fee
(minimum total fee is
� 289��
Ithe electricalinstaNaGon described herein c
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WITHIN 18 MONTHS
FOR OFF�E USE ONLY
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Request Dat �/ Rough-in Inspection Required7 ❑ Yes No Inspection Other Than Rough-In: Ready Now � WIN Call
��V 0� You must call the inspector when readyl Date Ready:
i certdy that 1 am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the e�ectrical work at