P - 78787f�ST FOR ELECTRICAL INSPECTION
1� 0 7 3 6 41 �nesota Board of Electricity
� � iS21 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
, www.electricity.state.mn.us
Identify the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
to 400
/FEEDERS
l0 Ampere � $5
200 Ampere � $10
�MMUNICATION, REMOTE CONTROL,
CIRCUITS OF LESS THAN 50 VOLTS
iystem Device or Apparetus � $.50
ADDITIONS TO THE GENERAL F
IILY DWELLINGS (PER UNIn
2 Units � $50 Per Unit
4ddiUonal Und � $25
OTHER ADDITIONAL FEES
b Retrofit � $25 per Fature
r Pivot Irtigatron Boom � S40
actured Home Park Lots � $25
atinnal Vehicle Park Sites � $5 �
� I Speciallnspection
_ _THIS INSTALLATION MAY BE__ __ � _ _�, __,_ ______
FOR OFFlCE USE ONLY
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� 1 O 7 3 6 4 1 i�
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers u m 10 KVA �$10
Transformers over 10 KVA � $20
Transformer I Power Su I for S' ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service a�lor Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$8(
%�L�� Z� ,00 (minimum total fee is $20) �3�.•
the electricalinstallation described
�$30 Per Hour �—� �•,�;��� 1 J r —/ I
� $ 31 per Mile �� r' `
ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
I certi(y ihat I am the ❑ L�CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical worlc at
BOARD OF ELECTRICITY COPY
INS'fAUCT10N8 a4 BACK OP YELLOW COPY