P - 75837REQUEST FOR ELECTRICAL INSPECTION
� Minnesota Board of Electricity
1� 3 4 7- 5 0 5� 1821 University Avenue Suite S-128, Sairrt Paul, Minnesota 55104
r (651) 642-0800 TTY/MRS 1$ 3529 -
www.electricity.state.mn.us�� ��%��' � � �
Identlfy the work red by this request
❑ NEW EMODEL ❑ ADDf170N ❑ REPAIR
GENERAL FEES Outdoor LI htln Stendard (� $1
SERVICES / POWER SUPPLIES Tra(flc SI Startdard �$5
0 to 4� Am re�$25 S lemerdal Fee �$20
401 to �0 re�$50 T�a�formers u to 10 KVA �$10
Above 8� re �$75 Transbrmers over 10 KVA �$'l0
CIRCUITS / FEEDERS Transfomrer / Power S for Si / Outl'me Li '�$5
0 to 2� Am re� . ONE & TWO FAMILY DWEWNGS, EACH UNR
Above 200 re �$10 Includes the Service and/or Powier Supply up to 500 Arttperes, All
ALARM, COMMUNICATION, REMOTE COMROL, SIGNALING Cira�ts and Two Ir�spectlon Trips Each Dwe Unit �$BO
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS AddGonel I 'on T �$20
Eech Svstem Device or Aoaaratus �$.50 ImresUaaWe Fee —-- rr
3 to 12 UNb �$50 Per Unft
Eech NddiUonal Unit � �5 f-0t �1Dfl1
OTHER ADDITIONAL FEES
Li ' Retrofit � $25 r Fbdure
Center Pivot I�i atlon Boom C� $40
Menutactured Home Park Lots �$25 i here certa
R�tional Vehicie Park S'� � $5 "01�' �'
Se Bo ins on � $'LO
S I n�$30 r Hour �
S' Ira on �$.31 r N61e
THIS INSTALLATION MAY BE ORDERED DISCONNECTE
FOR OFFlCE USE ONLY
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tOtel fee IS $20) � �
fhe elechical ir�eO�On descnbed heretn cn the da�s s�:
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COMPLETED WITHIN 18 MONTHS
I cert(fy that I am the �'CiCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspectlon of the elecGri�l work at
Job Addr�s ( Box, or Route No.) Cfly Zip Code
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7/1P2000 BOApD OF ELECiA1Ci7Y COPY
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Master License
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ON BACK OF YELIOW COPY