P - 79460�.-266-785 -a��
. ap
IdentiTy the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION
GENERAL F
SERVICES / POWER SUPPLIES
0 to 400 Am ere �$25
401 to 800 Am ere �$50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Amcere � $5
:UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Anoaretus �$.50
Each Additional Unit �
FEES
Center Pivot Irtigation Boom � $4(
Manufaclured Home Park Lots � g
Recreatlonal Vehicle Park Sites �
Separate Bonding Inspection � $2i
Soecial Insoection � �30 oer Hour
REQUEST FOR ELECTRICAL INSPECTION
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
�j�,�,lp�ir lx�-� - 33 _
..: .. _ M—_� i,i✓1i-..�
Outdoor Li htin 3tandard � $1
Traffic Si nal Standard (� $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer I Power Su I for Si ns / Outline Li htln �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dweliin UnR �$8f
Additionaf Ins ection Tri s�$20
Investi ative Fee
Reinsoection Fee � $20
total fee is
I herebv ceNN that i insoected the electrical installaGon described herein on the datee
THIS tNSTALLATION MAY BE ORDERED DISCONNECTED 1F'f�10'rG�MPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
�IIIIIIi�IIIIIII�IIIII11111IIIIIIII�I11111II11III1 �
�E 1 c� 6 6 7 B 5 8�E ��3� �.n �-r�
I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe electrical work at: