P - 77860REQUEST FOF� ELECT�ICAL INSPECTION
Minnesota Board of Electriciry `�
1� 3 4 7- 3 4 0 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 =
www.electricity.state.mn. us
Identity the wark covered b� thi request:
❑ NEW ❑ REMODEL DDITION ❑ REPAIR
GE ERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am re �$25
401 to 800 Am re � E50
Above 800 Am re � $75
CIRCUITS / FEEDERS
0 to 200 A re� E5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Apparatus �$.50
3 to 12 Units �$50 Per Unit
Each Additional UnR � $25
OTHER ADDITIONAL FEES
Li htin RetrofR �$.25 r FiMure
Center Pivot Irrigation Boom f� a40 ♦
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sftes � $5
Separate Bonding Inspection � $20
Special Inspection � $30 per Hour
Speaal InspecUOn � $.31 per Mile
THIS INSTALLATION MAY BE ORI
� $1 / .
Su lemental Fee � $20
Transfortners u to 10 KVA �$10
Transfortners over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Ci�cuits and Two In ion Trips Each Dwelling Unft �$8(
Additional Inspection Trips � $20
Investiaative Fee
FOR.PFFICE U�E ONLY
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I ceRi(y ihat I am the ❑ LICENSED CONTRACTOR ❑ COMPANY
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thatlinspected the electrical
IF
BOARD OF ELECTAICRY COPY
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total fee is
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described herein on the dates stated:
DATE
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c�,w D�TE
G_O�� � ( KJ[�!
WITHI ONTHS
and hereby request inspection of the electrical work at:
INSTRUC710NS ON BACK OF YELLOW COPY