P - 79532;1-154-072 �
Identity the work covered by this request:
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am ere �$25
401 to 800 Am ere �$50
Above 800 Amuere � $75
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. state.mn. us
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Outdoor Li htin Standard � $1
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li hGn �$5
s ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service anNor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelli Unit �$8C
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20
Each S stem Device or A aratus �$.50 Investi atrve Fee
ADDITIONS TO THE GENERAL FEES Reinsoection Fee �$20
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Lighting Retrofd � $25 per Flxture
Center Pivot I' ation Boom �$40
Manufactured Home Park Lots (� $2 .
I herebvi ceNN that I
fee is
an the dates a�d:
Special Inspection (� $.31 per Mile ( —�""J �Z �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED I� NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspectton Required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
�a +�O'� You must call the inspector when ready! Date Ready:
I certi(y that i am the ❑ UCENSED CONTRACTOH ❑ COMPANY ❑ OWNER and hereby request inspectiai of tlie electrical work ffi:
E&00001A-13 7/1/2000 BOARD OF ELECTFiICRY COPY IN87AUC710NS ON BACK OF �'ELLOW COPY