P - 81563REQUEST FOR ELECTRICAL INSPECTION
' � Minnesota Board of Electricity
�� �� 3�� 8�� �a 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
- � � (651) 642-OS00 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us " '
Identify the work covered by this request: �� �G
EW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Tra�c Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transformers u io 10 KVA �$10
Above 800 Am ere �$75 Transfortners over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li hti �$5
0 to 200 Am ere �$5 l� �" ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S stem Device or A aratus (� $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinsoection Fee �$20
Each Additionai Unit � $25
OTHER ADDITIONAL FEES
Manufactured Home Park Lots �
Recreational Vehide Park Sites �
Seoarate Bondina Insuection � $;
FOR OFFICE USE WILY
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total fee is $20) 6Z 4�
that I insoecied the electrical installatlon
I certify that I am the �ICENSED COMRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the eleCtrical work at:
Job Address (Street, Box, or Route No.) Ciry � Zp Code
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Sec[ion Township R ge Fire No. Coun
Occupant �
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PowerSupplier S A�� Address
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Electrical Contractor / Company Name
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Mailing Address (Contractor, Company or Owner Performing Installation)
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Phone
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License Number
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allation) Phone
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OF ELECTRICRY COPV INSTHUC710N3 ON BACK OF YELI.OW COPY