P - 79576REQUEST FOR ELECTRICAL INSPECTION
1,��� � H� �P Minnesota Board of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
e��m� (651) 642-0800 TfY/MRS 1-800-627-3529
www.electricity.state.mn.us '��'
Identity the work cavered 6y this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR i �/
GENERAL FEES Outdoor Li htin Standard �$i
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transfortner / Power Su I for Si ns / Outline Li htin �$5
0 to 2� Am re�$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Inciudes the Service andlor Power Suppry up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$SO
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S stem Device or aratus �$.50 Invesfi ative Fee
ADDITIONS TO THE GENERAL FEES Reinsoection Fee �$20
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Lighting Retrofit � $25 per Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots �$25 �
Recreational Vehicle Park Sites �$5 t
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I hereby certifY that I inspected the e
� � Special Inspection �$.31 per Mile I I
THIS INSTALLATION MAY BE ORDERED DISCONNECT
FOR OFFICE USE ONLY
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ED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of The electrical work at:
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INSTRUCT10N3 ON BACK OF YELLOW COPY