P - 82456, 1-032-123 � s
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Identity the work covered by this request:
❑ NEW ❑ REMODEL 8;4DDITION ❑ REPAIR
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
�C�-� Q � -L+� �.
0 to 400 Am ere �$25
401 to 800 Am re (� $50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am re � $]0
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Cemer Pivot Irtigadon Boom �
Manuiactured Home Park Lots
Hour
�
Traffic Signal Standard � $5
Su�plemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su for Si ns I Outline Li hti �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
lncludes the Service andlor Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin UnR �$SO
AddRional Inspeclion Trips � $20
Investlaafive Fee
1
FOR OFFICE U5E ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection
/O "� !�VV You must call the inspector when readyl � Date Reac
I certify that I am the �UCENSED CONTRACTOR ❑ COMPANY ❑ OWNER
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total fee is $20
%�-� _ � �
�T COMPLETED WITHIN 18 MONTHS
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O[her Than Rough-In: Ready Now ❑ Will Call
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and hereby request inspection of the electrical work at