P - 79564REC�UEST FOR ELECTRICAL INSPECTION
� Minnesota Board of Electricity `�
1� 1 4 7� 5 O 8 ��e 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�� v (651) 642-0800 TTY/MRS 1-800-627-3529
�
www.electricity.state.mn.us '� �
Ideniify the work covered by this request:
EW ❑REMODEt ❑ADDITION ❑REPAIR
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re � Su emental Fee �$20
O7 to 800 Am ere �$50 Transfortners u to 10 KVA �$10
Above 800 Ampere �$75 Transiormers over 10 KVA �$20
Above 200 Am ere (� $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A ratus �$.50
ADDITIONS TO THE GENERAL FEES
ditional Unit � 9
OTHER
Retrofit � $25 i
! Home Park Lots �
Vehicle Park Sites �
� $.31 oer Mile
Transfwmer / Power Su I for Si / Outline Li 6n �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 5� Amperes, All
Circuits and Two Inspection Trips Each Dwellinq Unii �$8(
Fee �
75PECTOR USE ONIV
u6
I insoected the
THIS INSTALLATION MAY BE ORDERED DISCONNECT
FOR OFFlCE USE ONLY
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Yes ❑ No
iinimum total fee is $20)
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all tion described herein on the dates slated:
DATE
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:.___--- _ 3 , �
�ED WITHIN 18 MONTHS
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��'f� i..�V� You must call the inspector whe�ready! I Date Ready: � I
1 certHy that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at