P - 77535REQUEST FOR ELECTRICAL IN ECT N ,� �"
1 �,8 �� �e � � 8 � Minnesota Board of Electricity �����ab� �-�= '� I
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1821 University Avenue Suite 5-128, Sain Paul, Minnesota 55104
(651) 642-0800 TTYIMRS 1-800-627-3529 www.electricity.state.mn.us �<�
Describe -using the back of the white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Lighting Standard @$1
SERVICES / POWER SUPPLIES Traffc Si nal Standard $5 i
0 to 400 Ampere $25 Supplemental Fee $20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Amcere (�D $75 Transformers over 10 KVA $ 20
ALARM, COMMUNICATION, REMOTE CANTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Ap aratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PE
3 to 12 Units @$50 Per Un
Each Additional Unit @ $25
Lightin Retrofit @ $.25 per Fixture
Center Pivot Irrigation Boom @ $40
Manufactured Home Park Lots a$25
Recreational Vehicle Park Sites $5
Se rate Bondi Ins ion $20
Special Inspection $30 r Hour
Special Inspection $.31 per Mile
S INSTALLATION MAY BE ORDERED
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L8204883
Transformer I Power Su I for Si ns / Outline i htin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
Investiaative Fee
TOTALFEE
total fee is $20)
aby cert'rfy that I' d the electri ' tallation described herein on the dates stated:
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;EDI NOONED / �pTE
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ED IF NOT COMPLETED WITHIN 12 MONTHS
Date: Rough-in Inspection Required? � Yes ❑ No Inspection Other Than Rough-In: 0 Ready Now�ill Call
�/"� �" Q� You must call the inspector when ready! Date Ready:
I certi(y that I am the � LICENSED CONTRACTOR 0 COMPANY �OWNER and hereby request inspection of the electrical work at:
Job Site Street Address ��' `
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Township Section Range Fire No. County
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� OwnerlOccupant
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�a tor / Company Name
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ig Address (Contracror, Company or Owner Performing I�,
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Please Provide Two (2) Phone Numbers Incluaing area coae
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Utllity Address
Contractor License Number Master Electrician or Power Limited Techni�
( License Number
stallation)
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ation) Please Provide Two (2) Phone Numbers Including Area Code
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