P - 79582REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity �
1� 2 5 3� 4 1 0 a0�� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� ; � � (651) 642-OS00 TTY/MRS 1-800-627-3529
, ;� ...�
www. electrici ry. state. mrc. us
Identity the work covered by this request:
NEW ❑ REMODEL ❑ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard �$1
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 Amqere �$75 Transformers over 10 KVA �$20
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UN
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
CeMer Pivot Irrigatlon Boom � $4
Manufactured Home Park Lots �
Recreational Veliide Park Sites �
Transformer 1 Power Su I for Si ns I Outline Li h6n �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$80
Additional Ins ection Tri s�$20
Investi ative Fee
Reinsoection Fee � $20
I frerebv cer�lv that I
rti
� � Special lnspection �$.31 per Mile I I `—
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF
_ FOR OFFICE USE ONLY
I llllfl llill 1111111111 Rllll Illll fli11IIIII111111lI
�4 ] Z 5 3 4 1❑ 3�E
(minimum total fee is $20
C�W'
;al installation �scribed herein on the dates stated:
, � w,h
;... � �
wh
. � /� enZ.
6
�LETED WITHIN 18 MONTHS
� �a'�s �SSo
Rough-in: ❑ Re�dy Now Will Call
( '�' �— �7j ' You must call the inspector when ready! I Date Ready: �
I certify that I am the �f LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecfical work at: