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Identity the work covered by this request: �
❑ NEW ❑ REMODEL O ADDITION ❑
0 to 400 Am ere �$2:
401 to 800 Am ere �:
Above 800 Am re � 9
CIRCUITS / FEEDERS
0 to 200 Ampere � $5
Above 200 Am re � 9
ALARM, COMMUNICATION,
CIRCUITS, CIRCUITS OF LI
Each Svstem Device or
THAN 50 VOLTS
�ratus � $.50
Lighting Retrofit � $25 pei Fixture
Center Pivot Irri� a6on Boom �$4!
Manufactured Home Park Lots �
Inspectbn � $2i
� $30 oer Hour
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity ��
1821 University Avenue Suite S-128, Saini Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529
www.electricity.state.mn.us '��'
o.FL� �.�-�c.(_ ��a<'�{��v�'
Traffic Si na1 Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transiormers over 10 KVA � $20
Transfortner / Power Su I for Si ns I Outline Li htin �$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 �$8(
Additional Inspection Trips � $20
� Investiaative Fee
TOTAL FEE I�O �� I
` (minimum total fee is $201
I insoected ihe
herein on me detes slered:
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THIS INSTALLATION MAY BE ORDERED WSCONNECTEO IF NOT COMP�ETED WITHIN 18 MONTHS
FOR OFFlCE USE ONLY
1 i�i�i� i�i�� ����i �ii�i ����� t«� i���i ���� ���� �, �.
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Request Date: Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-In: eady Now ❑ wll Call
�+ �� � You must call the inspector when ready! Date Ready:
I certify that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: