P - 79544� REQUEST FOR ELECTRICAL INSPECTION
1 2 0 2 5 8 8 `e ° Minnesota Board of Electricity
o � �A ' 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
, a `a" (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us � � '�'
Identity the work covered by this request: �, 71 �� � J� /� � ��� G, „ a j������� �� �,,g
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NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard �$1
SE ICES / POWER SUPPLIES Traffic Si nal Standard �$5
t 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
ve 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li h6n �$5
0 to 200 Am re �$5 j ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Supply 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 Insoection Trios �$20
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
CeMer Pivot Irrigation Boom � $
Manufactured Home Park Lots �
Recreational Vehicle Park Sites �
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:cial In 'on � $30 er Fbur """""'"""�"
:cial InspecGon � $.31 per Mile
i1S INSTALLATION MAY BE ORDERED DISCONNECTE
^ .— ^— FOR OFFICE US�NLY
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Fee �
total fee is
I inspected the electrical installadon described herein on the dates stated:
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I certify that I am the �LiCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the eiectrical work aY.
Job Address (Sheet, Box, oute Nq.) City � Zip Code
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BOAHD OF ELECTRICRY COPY INSTRUCTONS ON BACK OF YELLOW COPY