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Identify the work covered by this request:
❑ NEW ❑ REMODEL ❑ADDITION ��
GENERAL FEE
SERVICES / POWER SUPPLIES
0 to 400 Am ere �$25
40t to 800 Am ere �$50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CO
CIRCUITS, CIRCUITS OF LESS THAN 50
Each S tem Device or A aratus �
ADDITIONS TO THE GED
ADDITIONAL FEES
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
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Traffic Signal Standard � $5
Supplemental Fee � $20
Transformers up to 10 KVA �
Transformers over 10 KVA �
Includes the Service andlor Power Suppiy up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$8(
Additional Ins ection Tri s�$20
Invest6 ative Fee
Reinsoection Fee � $20
total fee is
ManufaClured Home Pa�k LotS � I hereby cert' that I inspected Uie eledrical instaliation described herein on lhe dates stated:
RecreaUonal Vehicle Park Sites � fl01C�" °"�
Se arate Bondi In 'on � $20
S ial Ins ection �$30 r Hour �`"` �"0N °ATE
S ial Ins ecdon �$.31 er Mile � CZ
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 M NTHS
FOR OFFICE USE ONLY
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Ready Now ❑ WIII
��', � � �}'L: Q � � Y� must call the inspectar when readyl � Date Ready: � . �
I certify thatl am the� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of The elecVical wak at