P - 76352REQUEST FOR ELECTRIC.f�jL.���� TION '
._ � � � � � � 3 � � � Minnesota Board of Electricity (�
1821 University Avenue SuRe S-128, i�t Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-8 29 www.edectricity.state.mn.us �"
Describe -using the back of the white copy d necessary - the work covered by this requ�t: ,
�.�Da,nfv�r��D i��n ,�.�,���r�a � a 1� ;..�,��
SERVICES ! POWER SUPPLIES
0 to 400 Am Bre $25
401 to 800 Am ere $50
Almve 800 Am re $75
CIRCURS / FEEDERS
0 M 200 Am re $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCURS, CIRCUITS OF LESS THAN 50 VOLTS
Each S m Device or $.5Q
ADDRIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UN
3 to 12 Un(ts @$50 Per Unit
Each Addftiunal Un(t @ $25
OTHER ADDITIONAL FEES
Lightlng Retrofit (a� $.25 �r Fbdure
Ceider Pivot Irrigatlon Boom (d� $40
Manufactured Home Parlc Lots $25
Reaeatlonal Vehicle Park Sft� $5
Se Bomi Uis on $20
Special Inspectlon Cd3 $30 aer Hour
F1'F_Tii�
ONE B TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Sarvice and/or Power Supply up to 500 Amperes, Atl
Ciraiits and Two Inspection Trips Each DweWng Unit @$80
AddiUonallr�s onT' $20
Investlgative Fee
Reins on Fea $20
TOTALFEE /�
(minimum total fee is $20) ��.1V �
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I hazeby certlty that I I�peded fhe elecUical tr�➢atlon desamed herehi on the dat� ata�:
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'ALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS ^_�
�` FOR f}F�E U3E ONLY �/
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ua�e: Rough-in Inspectlon Required7 ❑ Yea �No Inapecdon Other Than Ra�gh-In: 0 Ready Now [�9Gm Cell
� �� �� You rtwst cap the irrepector when readyl Date Ready.
I certify that I am the CENSm CONTRACTOR � COMPANY ❑ OWNER and hereby request ms�Ction of the electri�l wark at