P - 78628REQUEST FOR ELECTRICAL INSPECTION
�. 3 b 1 0 5 5 �� Minnesota Board of Electriciry
_ � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
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www. electri ci ty. state. mn. us
Identiiy the work covered by this request: Bi� ��, y A' 21",� � N �� S•6-rt� t�j •r
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❑NEW ` EMODEL ❑ADDITION ❑REPAIR (p� �p� A�O s�/ Qa+
GENERAL FEES Outdoor Li htin Standa �$t
SERVICES / POWER SUPPLIES Traffic Sianal Standard �$5
0 to 400 Ampere � $;
401 to 800 Amoere �
C CUITS / FEEDERS
0 to 200 Am ere �$5
Above 2� Am re � $10
ALARM, COMMUNICATION, REMOTECONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
CeMer Pivot Irrigation Boom � $4
Manufactured Home Park Lots �
Recreational Vehicle Park Sites �
� $.31 per Mile
,LATION MAY
Transiormers u to 10 KVA �$10
Transfortners over 10 KVA � $20
Transformer / Power Supply for Signs / Outline Lighting �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$8C
Additional Ins ection Tri � $20
Investi ative Fee
Reinsoection Fee � $20
FOR OFFICE USE ONLY
����i�i ����i ����� ��ii� ��iii i�lll I�IIlIIIII ICII li�#
�F 1 3 6 1 O S 5 5�E
(minimum tota► fee is $20) �D' �
1p
rt I inspected the electriql insta�5on described herein an Ihe �s �ated:
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IF NOT COMPLETED WITHIN 18 MONTHS
I certify that�l am th�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecqon of the electrical work at: