P - 81717REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity � .
1-.� � 1�� O� � 182� 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 work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR I
GENERAL FEES Outdoor Li htin Standar �$1
SERVICES / POWER SUPP�IES Traffic Sianal Standard �$5
0 to 400 Am ere �$25
401 to 800 Ampere � $50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am re �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIFICUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus �$.50
OTHER ADDITIONAL FEES
Lightlng Retrofit � $.25 per Fi�Rure
Center PNot Irrioabon Boom � $40
nspection � $21
� $30 oer Hour
Trans(ortners over 10 KVA � $20
Transformer / Power Supply for Signs / Outline Lighting �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Senrice andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$8[
Additional Inspection Trips � $20
Investiaative Fee
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total fee is
Special Inspection �$.31 per Mile � � � 28-'`O � �
TH1S INSTALLATION MAY BE ORDERED DISCONNECTED IF N COMPLETED WITHIN 18 MONTHS
FOR OFF�E USE ONLY
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Requ Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: Ready Now Will Call
�'�..1 � � You must call the inspector when ready! Date Ready:
I certify that f am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Address (Street, x, or Rout Cily Z�p Code
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Section Township Range Fire No. Couniy
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� BOARD OF ELE(
License Number Master License
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