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GENERALFEES
$ERVICES / POWER SUPPLIES
0 to 400 Amcere � S25 r9 A
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TlY/MRS 1-800�27-3529 www.electricity.state.mn.us
t Describe -using the back of the�ite copy if necessary - the rrork covered by this request:
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALIN�
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus E.50
ADDITIONS TO THE GENERAL FEES
2 Units @ $50 Per Unit
Additional Unit @ $25
� Retrofit @ $.25 per Fi�ure
Pivot Ircigation Boom @ S4(
ctured Home Park Lots � $
Gonal Vehicle Park Sites �
Su lemental Fee $20 �
Transformers u to 10 KVA S10
Transformers aver 10 KVA $ 20
Transformer / Power Su I for Si ns I Outlir�e Li htin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Cirouits and Txro Inspection Trips Each Dwelling Unil @$80
Addi6onal Inspection Trips @ $20
Investiaative Fee
(minimum total fee is $20) I %�0��
THISARFAFORINSPECTORlI5EQ1Y �
I,,h,e/reby ceAi(y that i inspec0ed the elechical installa0on described herein on the dates stated:
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R uest Dale: Rough-in InspecGon Required? ❑ Yes No Inspedion Other Than Rough-In: ❑Ready Now 11 Call
�" � You must pll the inspeclor when ready! Date Ready:
I certify tliat 1 am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the etectrical work at::
Jab Site AdMcss (�reet Box, a Route No.
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30
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F') Please Provide Two (2) Phone ►�mber(s) Indudirg Mea G
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90ARD OF EIECTRICT' COPY E&00001M14 8.1