P - 81684REQUEST FOR ELECTRICAL INSPECTION
1 � � � � � � Minnesota Board of Electricity ' `
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 s�
���s (651) 642-0800 TTY/MRS 1-800-627-3529 -
www. e lectricity. state. rnn. us
ItlentiTy the work covered by this request:
❑NEW ❑REMODEL ❑ADDITION ❑REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am ere C� $25
401 to S00 Ampere � $50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Amcere � $5
RM, COMMUNICATION, REMOTE CONTROL, SIGNALING
:UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
TIFAMILY DWELLINGS PER UN
3 to 12 Units �$50 Per Unit
Each Addftional Unit � $25
OTHER ADDITIONAL FEES
Manufactured Home Park Lots � $
Recreational Vehicle Park Sftes �
Separate Bonding Inspection � $21
Soecial Insoection � $30 cer Hour
D�l fG � f'1 �
Outdoor Li htin Standard � $t
Traffic Signal Standard � $5
Su lemental Fee (� $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer I Power Su I for Signs / Outiine Lighting �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and�or Power Suppty up to 500 Amperes, All
Circuits and Two inspection Trips Each Dwellin Unit �$8f
Additional Ins�ection Trios � $20
Fee �
total fee is
I herebvi certifv Nat I insoected the eledrrc;al installation described herein on
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NITHIN 18 MONTHS
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FOR OFFICE USE ONLY
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Requ Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: eedy Now ❑ wll Call
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You must call the inspector when ready! Date Ready:
I certify that I am the`�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecTion of the electrical wwk at