P - 78482REQUEST FOR ELECTRICAL INSPECTION
�,, � � � � � � � � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
ww w. electrici ty. state. mn. us
Identify the work covered by this request:
❑ NEW QREMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
SEFiVICES / POWER SUPPLIES
0 to 400 Am ere �$25
401 to 800 Am re�$50
Above 800 Am re � $75
CIRCUITS / FEEDERS
200 Amoere � $5 °
RM, COMMUNICATION, REMOTE CONTROL, SIGNALING
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparalus �$.50
ADDRIONS TO THE GENERAL FEES
OTHER ADDITIONAL FEES
Retrofil � $25 oer Fodure _ _
.. ..........:.......
;�� .,� ,
�� •
,� #u��, �.,,- -
,".F. ��1:
/ •
Outdoor Li htin Standard � $1
Tra(fic Si nal Standard � $5
Su � lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for S' ns / Oudine Li hd �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Indudes the Service and�or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Tri Each Dwellin Und ��8C
AddiGonal Inspection Trips � $20
Irneseaative Fee
�
total fee is $201 �rS
� me aaz� s�tea:
Se rate Bondin In 'on � $20 � `"�`
S aal Ins ection �$30 r Hour ""` "�"01 DA7E�
.o
S'al In ection �$.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF T COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
I 11111! I�III IIIII filll Illli Illii 1i1111111fi 1111 Illi ��
�E 1 3 4 7 3 4 6 7�E ��� '
�
I/ Gf�/G� I You must call the inspector when ready! ' Date Ready: I
� ��/
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY � uWNER and hereby request inspection of the elecVical wrork aT.