P - 80501REQUEST FOR ELECTRICAL INSPECTION
�� � 014 Minnesota Board of Electricity
�`" 1821 Universily Avenue Suite S-128, Saint Paul, Minnesota 55104 �
�� (651) 642-0800 TTY/MRS 1-800-627-3529 ��`i�
��� www.electricity.stc�te.mn.us ��'
Identity the woAc covered by this request:
❑ NEW IYREMODEL ❑ ADDITION ❑ REPAIR ��'7 (/�/) U.�l�l I D�/ !/ 7� D S S�
4ot to 800 Am ere (� $50
Alwve B00 Am ere � $75
IRCUITS / FEEDERS
0 to 200 re � $5
Above 200 Am � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S em Device or aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 ro 12 Unils � S50 Per Unit
Home Park Lots �
'ehide Perk Sites �
Outdoor Li htin Standard � $1
T2flic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transfortner / Power Su (or S' ns / Outline Li htin �$5
ONE & iW0 FAMILY DWELLINGS, EACH UNIT
Indudes Ihe Servfce andlor Power Supply up to 500 Amperes, All
Circuits and Two Ins tion Trips Each Dwellin Unit �$8C
Additional Insoection Trios � S20
�
I her�vi cerliN thet I inspectetl the
total fee is
on Ihe detes sleted: I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTFIS
_�' FOR OFFICE U:iE ONLY '
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- You must eall the inspector when readyl Date R�dy:
l ceN(Jr tl�9t I am the ICENSED CONTRACTOH ❑ COMPANY ❑ OWNER and hereby request inspection ot the electrical work et
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