P - 79864REQUEST FOR ELECTRICAL INSPECTION
1� U�1 � 9 9 3 Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
����� (651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. state. mn. us
Identity the wark covered by this request:
❑NEW REMODEL ❑ADDITION ❑REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am re (� $� '
401 to 800 Am re �$50
Above 800 Am re � $75
CIRCUITS / FEEDERS
Q 0 to 20� A re �
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER AODITIONAL FEES
Li hti Retrofit �$25 r Fixture
CeMer Pivot I' ation Boom �$40
Manufactured Home Park Lots � $25
� � D@f HOUf
Outdoor Li htin Standard � $t
Traffic Si nal Standard � $5
Su demental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transfortner / Powar Su for S' s l 0utline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Ir�ludes the Service and/or Power Supply up to 500 Amperes, Ali
Circuits and Two Inspection Trips Each Dwellin Unit �$8f
Additlonal Ins ection Tri s�$20
Investi ative Fee
Reinsoection Fee � S20 5�w fe Q�? •
I herebv certifv that 1
total fee is $20) � T �
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 1
FOR OFFICE USE ONLY
I I1f111llfll Illil II11I IIII! IIIII11Ili IIIII lill llll
on tlie �es s�ed:
a�h
+. 22 --G �
DATE
�- ��� �i Z�
8 MONTHS
�E 1 O B 1 9 9 3 6�E Q�.r.., �'" �" `" ��is�
� � �f(J
❑ Ready Now J,�Will Cell �
IJl�f O,z I You must call the inspectar when readyi � I Date Ready: �
i certify that I am the�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspectlon of 1he electrical wak at
E&OOOOtA-13 7/1/2000 BOApD OF ELEC7AICITY COPY INSTRUCIbNS ON BACK OF YELLOW COPY