P - 80148REQUEST FOR ELECTRICAL INSPECTION
� M+nnesota Board of Electricity �
� e���� 3�� �� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
a3��, (651) 642-0800 TTYIA+IRS i-800-627-3529
- www.electricity.state.mn.us " '
Identify the work cavered by this request:
❑NEW ❑REMODEL ❑ADDITION ❑REPAIRf�V%�1✓ "' � ��' / � �` � / ""' QL
GENERAL FEES Outdoor Li htin Standard �$1
S RVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Ampere �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 TransfoRners over 10 KVA @$20
CIRCUITS / FEEDERS Transfortner / Power Su I for Si ns / Outline Li hti �$5
0 to 200 Am re (� $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addftional Ins ion Tri s(� $20
Each S tem Device or atus �$.50 Investi tive Fee
ADDITIONS TO THE GENEFAL FEES Reins 'on Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAI FEE
�... �o i i..rt� Ld CFl1 De� i i..a (minimum total fee is $20)
OTHER ADDITIOP
Lightlng RetrofR � $.25 pe� Fixture
Center Pivot Irrigation Boom � $4(
Manufactured Hame Park Lots � $
Recreallonal Vehicle Park SRes �
I here� certilv that I
�cial Inspection �$.31 per Mile I I L�
iIS INSTALLATION MAY BE ORDERED DISCONNECTED IF
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FOR OFFICE USE ONLY �
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{ certiiy that I am the � LiCENSED CANTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or oute No.) City Zip Code
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S. ion Townshio anae Fire NO. COUnN
Occupant
Power Supplier
Electrical Contractor /
M ilina Address (Corn
Name
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or Owner Pertorming
Phone
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ailation) 3
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OF ELECTRICRY COPY
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Master License
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ISTRUCTIONS ON BACK OF YELLOW