P - 79825REQUEST FOR ELECTRICAL INSPECTION
° Minnesota Board of Electricity
1= 316 - 2 5 6 ��3 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
� � s ��� (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.
Identity the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR l �
GENERAL FEES Outd or Li htin Standard �$1
SERVICES I POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee (� $20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am re (� $75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su for Si ns / Outline ' h6n �$5
0 to 200 Am ere �d $5 ONE & 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, SIGNAIING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addrtional Ins ion Tri s@$20
Each S stem Device or aratus �$.50 Investi aUve Fee
ADDITIONS TO THE GENERAL FEES Rein ion Fee (� $20
MULTIFAMILY DWELLINGS PER UNI TOTAL PEE
3 to 12 Units �$50 Per Unit (minimum total fee is $2
Each Additional Unit �$25 F°p i"S°�cmn `"SE °"`r
OTHER ADDITIONAL FEES �y �� t/—�n— o
Li htin Retrofit �$25 r Fixture o��S
Center Pivot Irri adon Boom �$40
Manufactured Home Park Lots (� $25 � nereby cerdry mat � insspected n,e eledrica� instenatlon aescrined nerein on are dates stated:
Recreational Vehicle Park Sites "01GH1N �'�
Se arate Bondin tns 'on �
S ial Ins ion �$30 r Hour "N1LN�`�10N °��
S ial Ins ion �$.31 r Mile `�'� ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED 1 NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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I certiiy that I am the�CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical wwk ar
Job Address (Street, Box, or Route No.) Zip Code
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Sec[ion Township Range Fire No. Couniy
Occupant Phone � ` ��
Power Supplier A r ss
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E&00001A-13 7/1/2000
Master License
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BOMD OF ELECiAICTf COPY � STROCTWNS ON BACK OP VELLOW COPV