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I SERVICES I POWER SUPPLIES
REQUEST FOR ELECTRICAL INSPECTION "��'�
Minnesota Board of Electricity �, ��„
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us �;�s�
necessary - th� work wvered by jhis request:
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
Each Additional Unit @
Center Pivot Ircigation Boom @
Manufactured Home Park Lots
Tra�c Signal Standard $5
Sup lemental Fee $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns / Outline Li htin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each D ling Unit @$80
Additional Ins ction Trips $20
Investi ative Fee
Reins ection Fee $20
TOTAL FEE �q�, �
(minimum total fee is $20) �Jlid�� .
that I inspeded the electrical installation described herein on the dates stated:
DATE
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Special Inspection $30 per Hour EXPIREDIABANOONE� Al
Special Inspection $.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Date: Rough-in Inspection Required? ❑ Yes �o Inspection Other Than Rough-In: �teady Now �Nill Call
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You must cali the inspector when ready! Date Ready:
I certify that I am the �J,ICENSED CONTRACTOR ❑ COMPANY 0 OWNER and hereby request inspection of the electrical work ai
Job Site Street Address City
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Township Section Range Fire No. County �} �
or Owner Performing Installation)
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B (c ctor or
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�n dor License Number Master Electrician or P
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Please Provide Two (2) one N m ers I
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