P - 78630REQUEST FOR ELECTRICAL INSPECTION
° Minnesota Board of Electricity
�� 3����� �` � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us
Identiiy the work covered by this request: � � i �_
❑NEW �IEMODEL ❑ADDITION ❑REPAIR
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GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$'LO
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li hfi �$5
0 to 200 Am re�$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includ s the Service andlor Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Tri s Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20
Each S em Device or ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee �$20 �
OTHER ADDITIONAL FEES
Retrofit � $25 oer Fixture �
Recreatanal Vehicle Park Sites �
Seoarate Bondina Insoection � &
total fee is
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1 inspected the electrical installalion descri herefi on the dates staU
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F NOT COMPLETED WITHIN 18 MQAlTHy
FOR OFFICE USE ONLY
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Req st Date: Rough-in Inspection Required? Yes ❑ No Inspe
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I certify that I am the� UCENSED CONTRACTOR ❑ COMPANY ❑ OWNER
Other Than
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Now
and hereby request inspection of the electrical work at