P - 77704RE(�UEST FOR ELECTRICAL I SPECTIO /1
C/� Minnesota Board of Electriciry ��• <� �
1� 3 4 7� J`t O 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 =
www. electricity. state. mn. us
Identiy the work covered by this request: ��� G(� A�� �/?J /( ��%
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❑ NEW ❑ REMODEL ❑ ADDITION EP IR
GENERAL FE S Outdoor Li hHn Standard �$1
SERVICES I POWER SUPPLIES Treffic Si nal Standard (� $5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA � a20
CIRCUITS / FEEDERS Transformer / Power Su for S' ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING CircuiGs and Two Inspection Trips Each Dwellin Unit (� $80
CIRCUITS, CIRCUITS OF LESS 7HAN 50 VOLTS Additional Ins ion Trios �$20
Each S stem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Rei� on Fee (�
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
EeCh Additi0nal Und � $25 `O" �"SP`�0R1� °NLY
OTHER ADDITIONAL FEES
Li htin Retrofit �$.25 r Fixture
Center Pivot Irri ation Boom �$40
Manufaclured Home Park Lots �$25 � hereby certily that 1 inspecte
Recreational Vehide Park Sites �$5 R01GHN
Se arate Bondin Ins ec6on �$20
S ial Ins eCtion �$30 r Hour 1NSPE°t0N
S'al Ins � n�$.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NO'
FOR OFFICE USE ONLY
I IIIIII Illil Ilfll IIIII IIIII IIIlI Illf) IIIII illl INi
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total fee is
described herein on itre dates stated: I
� l e°- 7`° � �
WITHIN #8'MONTHS
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R uest D te: � iiough-in Inspection Required? ❑ Yes � No Inspection Other Than Rough-In: ,�j Ready Now U Will Call
� �`� v�� You must call the inspector when ready! Date Ready: /
I certi(y that I am the [�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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Job Address (Stree Box or R e No.) City Zip
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BOARD OF ELECTRICITY COPY
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INSTRUCTIONS ON BACK OF YELLOW COPY