P - 776101�174-967
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Identify the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION �EPI
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am re �$25
401 to 800 Am ere �$50
Above 800 Am re � $75
CIRCUITS / FEEDERS
0 to 200 Am re �
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S em Device or ratus �$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units � S50 Per Unit
Each Additional Unit � $25
OTHER ADDITI NAL FEES
Li Mi Retrofit �$25 r Fixtu e
Center Pivot Irri tion Boom �
Manufadured Hane Park Lots (� 5
Recreational Vehicle Park Sites � $5 �
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity �``
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 l"TY/MRS 1-800-627-3529 =
www.electricity.state.mn.us �C�� —�j�:e-1tJt"� _
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Outd Li htln Standard � $1
Trattic Si nal Standard � $5
Su lemerrtal Fee � $20
Transformers u to 10 KVA �$10
Transfortners over 10 KVA � $20
Transformer / Power Su I for Si ns I Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
GNALING Circuits and Two Inspection Trips Each Dwelli� Unit �$80
Additional Ins ection Tri � $20
InvesG ative Fee '
:S Reinspection Fee � $20
stated: I
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THIS INSTALLATION M BE ORDERE DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
OR OFFlCE USE ONLY � 7�( .p �
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Request Dat§: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rou h-In:
g ❑ Ready No Will Call
�` ,� You must call the inspector when readyl Date Ready:
I certi(y that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and her by request inspection of the electrical work at:
Job Address (Stree x, or Route No.) City � Zip Code *�
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Section Township Range Fire No. County
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Power pplier Addr
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Etectrical Contrac[or / Company Na Contractor License Number Ma ter License Number
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Mailing Address (Contrador, Comp y or Owner /P�grformi`ng Installation) �--�
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Authorized Sign (Contractor, Com n or Owner orming Installation) Phone
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�-�3 ������ BOAHD OP ELECTpICRY COPY INSTRUCTIONS ON BACK OF YELLOW COPY