P - 82517REQUEST FOR ELECTRICAL INSPECTION
1. C3f 41 g 4. 7 �� Minnesota Board of Electricity --
� � � 1821 University Avenue Suite S-128, Saint Paul, R4innesota 55104 `
� ; e e d: (651) Tl'Y/MRS 1-800-627-3529 �� '�
� ww .e r s .state.mn.us
IdentiTy the work covered by this request: �� ��� � n/
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR � `�-l'�
GENERAL FEES Ouidoor Li htin Standard �$1
SERVICES / POWER SUPPLIES TraBic Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 8U� Am re �$5� Transfortners u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS I FEEDERS Transformer / Power Su 1 for Si ns I Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20
Each S stem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins �on Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTA! FE
3 to 12 Units �$50 Per Unit (minimum total fee is $20)
Each Additional Unft � $25 F0N "�TOf "� °NLV
OTHER ADDITIONAL FEES
Liahtina Retrofit � $25 oer Fixlure
Manufactured Home Park Lots �$25 I hereb � mat I inspected tl�e electm:al insralla�on descnbed herein on the dstes
Recreational Vehicle Park Sites `�"�"" o
Seoarate Bondina lnsoflcGort � �, y�i .
FOR OFFICE U8E ONLY
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IN 18 MONTHS
I ceAify that I am the ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Ad�Ve�or Route o ( • �/ Cdy /►� A Zip Code �/J
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� Occupant
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:al Contractor / Company Na -r ,
D�PENDABLE :E �I�
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Coon R�p3d�r, ��uiN�5.5433
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No. ' � County
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80AAD OF ELECTRICT/ COPY
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