P - 79757� REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1-396-543 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
� (651) 642-0800 TfY/MRS 1-800-627-3529
www. electricity. sta te. mn. us
Identify the work covered by this request:
X XGEL ENEROY SAVER'S SWI7CH
❑ NEW ❑ REMODEI ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
O to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transfortners u to 10 KVA �$10
Above S00 Am ere �$75 Transfortners over 10 KVA �$2�
CIRCUITS / FEEDERS Transfortners / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am re �$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit �$80
CIRCUITS. CIRCUITS OF LESS THAN 5Q VO�TS Additlonal Inspection Trips �$20
Each S stem Device or ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinsoection Fee (� $20 .,,,
3 to 12 Units �$50 Per Unit
TOTAL FEE
total fee is $20)
FOF MSPECTOR USE ONLY
�$25 � i nereuy cemry ma� i ��speaad me eiec�r�cei �r.gr�iew� aescrinad nare�� o� me aeces smted:
� (�� $S RWGN IN �A�
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�OUf flNAL INSPECTION DA7E
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� �FOR OFFlCE USE ONLY --_
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I certify that I am the ❑ UCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elechical work at:
ttt-ooW7n-13 7n/Z000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY