P - 78402REQUEST FOR ELECTRICAL INSPECTION
1� 3 5 8- 3 9 0 s� e Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�� ��a�� (651) 642-0800 TTY/MRS 1-800-627-3529 - _
"` www.electricity.state.mn.us � ��y•
Identity the work covered by this request: %� n/6�( (� Zo0 y1,� �j l��..s-l�/ZL L 5�V �
❑ NEW EMODEL ❑ADDITION ❑ REPAIR �'y�/� G �i¢i.l� `� i7��E�!''� Y�-G." !L �P�W�L �
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 D ,(J 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 Transfortner / 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 Indudes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two In 'on Trips Each Dwelli UnR �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Insoection Trius �$20
Each S em Device or ratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Addi6onal Unit � $25
LgMing RetrofR � $25 per Fixture
Center Pivot Irrigation Boom � $4C
Manufactured Home Park Lots � $
Recreabonal Vehicle Park Sites �
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L__I Special Inspection �$.31 per Mile � �
THIS INSTALLATION MAY BE ORDERED DISCONNECTE
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FOR OFFICE USE ONI.Y
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Fee �
total fee is
thatlinsoectedthe electriralinstalla6on desaibed herein aithe
— � — J —�,
WITHIN 18 MONTHS
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I cert'rfy that I am the ��LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical Nrork at: