P - 81696REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity '�
� 50 � 7 4, � 5 8 8 �� � 1827 University Avenue Suite S-128, Saint Paul, Minnesota 55104
,e,�, (651) 642-0800 TTY/MRS 1-500-627-3529
www.electricity.state.mn.us " '
IdentiTy the wor c vered by this request:
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EW ❑REMODEL ❑ADDITIQN ❑REPAIR
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lementai Fee �$20
401 to 800 Am ere �$50 7ransformers u to t0 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
RCUITS / FEEDERS Transformer / Power Su I for Si ns I Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING CircuRs and Two Inspection Tri s Each Dwellin Unit �$80
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS Additional Insoection Trios C� $20
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
.TIFAMILY DWELLINGS (PER UNI�
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIOMAL FEES
LighNng Retrofd � $25 per Fixture
Center PNot Irrigation Boom � $40
Manufactured Home Park Lots � $25
Recreational VehiGe Park Sites � d A r
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that I insoecled the
total fee is $20) -
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S ecial Ins ection �$.31 er Miie —�-' - �-
THIS INSTALtATtON MAY BE ORDERED DISCONNECTED IF NO COMPLETED WITHIN 18 MO HS
POR OFFICE USE ONLY
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Request ate: l Rough-in Inspection ReqWred9 es ❑ No Inspection Other Than RougFrin: Ready Now 8 Call
v� v �/ � You must call Nie inspector when ready! Date Ready:
I cert'rfy that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical wodc at
E&OOOOtA-13 7/1/2000 BOAFiO OF ELECRi1GRY GOPY p'M71NW IIV193 YI� OI�4.A V� icrrvn wr.