P - 80490� REQUEST FOR ELEC7RICAL INSPECTION
Minnesota Board of Electricity � �
�1 176 835 ���r
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55704
�,e�;; (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us " '
Identity the work covered by this request: � e�'° 7 � M� � _�
❑NEW OREMODEL ❑ADDITION CJREPAIR
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GENERAL FEES Outdoor Li htin Standard �$1
SERVICES ! POWER SUPPLIES Traflic Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to S00 Am ere �$50 Transformers u to 10 KVA (� $10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelli Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S stem Device or ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinsoection Fee �$20
total fee is
Retroffi �$25 oer Fixture I I —
I insoected the electrical inslallation dr.scribed herein an tlie
Recreational Vehicle Park Sites �
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Special Inspecfion �$.31 per Mile � � f� ���d
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF T COMPLETED WITHIN 18 MONTHS
Fon o�ce usE or�r �
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I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) Ciry Zip Code
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Section Township Range Fre No. County �
� Occupant
Phone
Conhactor License Number
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dress (Contractor, Company or Owner Performing Installation)
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SignaNre (Contractor, Company or Owner Perfortning Installation) Phone
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BOAHD OF ELECTRICITY COPY MS'TRUCTIONS ON BACK OF YELLOW COPY