P - 77042REQUEST FOR ELECTRI AL � �TION �`�
I � � � n � _ � O O � Minnesota Board of Electricity �(�S � � �- ;'��„
�S 1821 University Avenue Suite S-128, Saint Paul, Minnesot 55104 �.:
(651) 642-0800 TTYIMRS 1-800-627-3529 www.electricrty.state.mn.us �:;��
uescrioe -using [ne oacK ot tne wnite copy ir necessary - the work covered by this request:
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GENERAL FEE ' Outdoor Lighting Standard $1
SERVICES / POWER SUPPLIES Traffic Signal Standard $5
0 to 400 Ampere $25 Supplemental Fee $20
401 to 800 Am ere $50 Transformers u to 10 KVA $10
Above 800 Ampere $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns I Outline Li htin $5
0 to 200 Am ere $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere $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 50 VOLTS
Each S stem Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit an $25
Irrigation Boom @
i Home Park Lots i
Vehicle Park Sites
Fee $20
TOTAL FEE
iimum total fee is $201 '�� �
I hereby certiy that I inspected the electncal installation descnbed herein on the dates stated: �
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'ALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS�
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Date: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now ill Call
��1�� You must call the inspector when ready! Date Ready:
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Street Address Ci�
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tl Utility � Electrical Utility Address
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(76�83-7080 � -
INSTRUCTIONS ON Bl1 OF YELL W COPY BOARD OF ELECTRICITY COPV
Fire No.
Please Provide
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Master Electrician or Power
License Number
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