P - 76057REQUEST FOR`�CE�ICAL INSPECTION
1 3 4 7 5 0 2� Minnesota eoard of Electricity
� � 1821 UnNersity Avenue Sufte S-128, Safnt Paul, Minnesota 551Q4
(651) 642-OS00 TTY/MRS 1-800-627-
` www.electricity.state.rrcn.us ���'%�� f1
Identliy the work covered by this request
❑ NEW ❑ REMODEL Df170N 0 REPAIR �� G.�c/� °� Q C..� � z
GENERAL FEES Outdoor Li ' Smndard �$1
SERVICES / POVVER SUPPUES Treific Si Sffinderd �$5
0 to 4� re�$25 emardel Fee �$20
401 to 800 Am re �$5� � Transtormers to 10 KVA �$10
A6ove 800 Am re�$75 Transfomrers over 10 KVA �$20
CIRCUITS / FEEDERS Transtormar / Power S for Si / OuUine LI (� $5
0 to 2� Am re�$5 ONE & 1W0 FAMILY DWELLINGS, EACH UNIT
Above 200 Am re�$10 ° Includes the Service and/or Povrer Supply up to 50D Amperes, Ap
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNAIJNG Cirarits and Two I an T' Each Dwe Unit �$BO
CIRCURS, CIRCUITS OF LESS THAN 50 VOLTS Addih'onal I on T' �$20
Each m Devlce or U�s �$•50 Imesti ative Fee
ADDRIONS TO THE GENERAL FEES Reins n Fee f� �0
MULTIFAMILY DWEWNGS PER UN
3 to 12 Units �$50 Per Unit
EaCh AddiUorml Unit �$25 r� u�mn � aw.r
OTHER ADDITIONAL FEES p�I/� — �O / � ��
Retrofit � $25 r Flxmre /(l � /D �/
Cerder Piwt I' n Boom �$40
Manufactured Home Park Lob �$'25 I hereby ac
R�reahonel dehicle Petk Sites �$5 �"�" w
Bo I 'on � �0
S al Iris on �$30 r Hour �''
S I n�$.31 r MGIe
� THIS 1NSTALLATION MAY BE ORDERED DISCONNECTED IF NOT (
FOR OFFlCE USE ONLY
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totSl fee is
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=D WITHIN j�MONTHS
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Request oaze: Hough-in Ir�spectlon ReqWretl7 �Yes V No Insp�tlon Other Than Rough-In: ❑ Ready Now�IMO Call
�� I�,� (' � Yai must cell the Inspector when readyl Dete Ready:
I certify that I em the ❑ LICENSED CONTRACTOR ❑ COMPANY �OWNER and hereby request inspection of the electric�l work at
Job Address (Street, Bmc, or Rou[e No.) Cily Zip Code
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MetWg Addr�s (Contractor, Company or Owner
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c[or Llcerme Number MasLer Lic
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