P - 80441REQUEST FOH ELEC1 HIGAL INSf'EC iIUN
�145 7 8 3 t Minnesota 8oard of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
' (651) 642-0800 TTY/MRS 1-800-627-3529 �.
y�—' � www.electriciry.state.mn.us
Identiry the work covered by this request: , � r`� � � � �
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❑ NEW ❑ REMODEL DDITION ❑ REPAIR �I 1 r� r� r'e L '
GE ERAL FEES 0 r Li hN Standa�d �$1
SERVICES I POWER SUPPLIES Traffic Si nal Standard � SS
0 to 400 A 0 a25 Su emental Fee �$20
401 to 800 re 0 a50 Trans(ortners u to 10 KVA � S10
Above 800 Am re� a75 Transfortners over 10 KVA �$20
CIRCUITS / FEEDERS Transfomrer / Power S tor S� ns / Outline Li ti�$5
0 to 200 re ��.5 ONE � TWO FAMILY DWELUNGS, EACH UNIT
Above 200 Am re� S�0 Includes the Seivic:e ancilor Power Supply up M 500 M�peres, All
AU1RM, CAMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two tns 'on Tri Each ' Urrit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 YOLTS Additional I ion T' s�$20
Each S em Device or tus 0 5.50 Imesti tive Fee
ADDITIONS TO THE GENERAL FEES Reinsoectan Fee �$20
Each Addidonal UnR �
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fee is $201LFC(/�
THIS tNSTALLATION MAY BE ORDERED DISCONNECTED !F NOT COMPLETED WITHIN 18 MONTHS
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� FOR OFFICE USE ONLY
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Request �ta: Rough-In Inspection Requfred4 Yes No Inspect(on Other Than RougA-In: Ready Now VYiN Cell
'�^ Z—Q' You must call the inapector when readyl Date Ready:
� I ce�ily that I am the �UCENSEG CONTRACTOR I.7 COMpANY ❑ OWKER and I�ereby request inspestion ot the elecuicai work aC
Job Address (Street, Box, w Route No.) Ciry �p �
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