P - 78623REQUEST FOR ELECTRICAL INSPECTION
1�2 8 2 2 8 9 Minnesota Board of Electriciry
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-0800 TTY/MRS 1-800-627-3529
www. electricity. state. mn. us
Identify the work covered by this request:
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❑ NEW ❑ REMODEL ADDITION ❑ REPAIF
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am re�$50 Transfortners u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su for S� ns / Outline Li hTi �$5
0 to 200 Am re�$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Ihcludes the Service and�or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins 'on Tri �$20
Each S em Device or tus �$.50 Investi tive Fee
ADDITIONS TO THE GENERAL FEES Rein 'on Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to �2 Units �$5o Per Unit (minimum total fee is $20
E2Ch AdddOnel Unit �$25 PoR INSPECTOR USE ONLV e�, �
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OTHER ADDITIONAL FEES /
Li hti Retrofit �$25 r FbRUre
Center Pivot Irri tion Boom �$40
ManufaCturBd Home Pa�lt LOtS �$25 I hereby ce' that I inspected the electricel instapeBan described herein on the � stated:
Recreatanal Vehide Park Sites �$5 101GH1N i��
Se rate Bondin In ion �$20 �Zj
S ial Ins ion �$30 r Hour �.'"9"E�T'°" , °",�
S epal In ' n�$.31 r Mile �'�i- ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspec�on of the elechical work at: