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Identity the work covered by this request: �, h
❑ NEW ❑ REPAODEL ❑ ADDITION �iE
GENERAL FEES
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paut, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us
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0 to 400 Am ere �$25 D
401 to 800 Am ere (� $50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 206 Am re�$5
Above 200 Am re (� $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADOITIONS TO THE GENERAL FEES
Lighting Retrofit � $25 per Fixture
Center Pivot Irriaation Boom � $4(
Outdoor Li hth Standard � $t
Traific Si nal Standard � $5
Su demental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 70 KVA � $20
Transformer / Power Su I for Si ns / Outline Li htin �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
CircuRs and Two Inspection Trips Each Dwelli Unit �$6(
Additional Ir�spection Trios � $20
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I her�vi certfv that I inspected the e�ctria
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total fee is
un tlre dat� staead:
S ial Ins 'on �$30 r Hour ''"` "'°""""" /
Special Ins p 1� < a��
pection � $.31 er Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MO THS
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-In: Ready Now ��II Call
0�� Z� � 4� You must call the inspector when ready! Date Ready:
I certiTy that I am the � LIGENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe efectrical work at:
EB-ODOOtA-13 7)t12i100 BOARD OF ELECTRICRV COPY INS7AUCTIONB ON BACK OF YELLOW COPY