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Identity the work covered by this request:
❑NEW ❑REMODEL ❑ADDITION �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
0 to 400 Ampere �$25 /`7 C/ � 4
401 to 800 Ampere � $50 �T
Above 900 Ampere � $75
�UITS / FEEDERS
0 to 200 Ampere � $5
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTROL, SIGI
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
Lighting Retro�t � $25 per Fixture
CeMer Pivot Irrigation Boom � $4(
Manufactured Home Park Lots � g
Recreational Vehide Park Sites �
Separate Bonding Inspection � $2�
Soecial Insoection � $30 ner Hour
, �a f� �-� �
ir Liahtina Standard � $1
Traific Si nal Standard � $5
Su demental Fee (� $20
Transfortners u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power S for Si ns / OWine ' Mi � SS
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unil �$8(
Additional Insceclion Trios � $20
total fee is
I insoected Me electrical instaAation described
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FOR OFFICE USE LY
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Request Date: Rough-in Inspeclion Required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑�II Call
You must call the inspecta when ready! Date Ready:
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY OWNER and hereby request inspeclion of the electrical work at:
Job Address (Street, Box, or Route No.) City ZP ��
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Sec[ion Township �{� Range Fre No. County
���. -? �'No��
p��p�t Phone
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Power Supplier Address
Contractor / Comparry Name
(Contractor, Company or Owner
or
Number
Installation)
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BOARD OF ELECTRICRV COPY INSTRUC710NS ON BACK OF YELLOW COPY