P - 81746REQUEST FOR ELECTRICAL INSPECTION &
�1 �� Minnesota Board of Electricity
����� f 8����� �°� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.u� " '
❑NEW ❑REMODEL ❑ADDITION ❑REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am ere �$25
401 to S00 Am ere �$50
Above 800 Am re � $75
CIRCUITS / FEEOERS
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofit (� $25 r Fixture
CeMer Pivot Irri ation Boom �$40
Manufactured Home Park Lots Q$25
Recreational Vehicle Park Sites �'i5� .�. _
y i
or Li htin Standard � $1
Traffic Si nai Standard � $5
Su plemental Fee � $20
Transtormers u to 10 KVA �$10
Transformers over 10 KVA � $20
Trar�sfortner / Power Su for S' ns / Outline ' htin (� $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 Dwelling Unit �$8(
Additional Ins ection Tri s�$20
Investi ative Fee
Reinsoection Fee � $20
(minimum total fee is
wa wsaECion use aav
I herebvi ceAifv Nat I insoected the electrical instailation described herein i
Special Inspectlon �$.31 per Mile � Z���
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPL�T�D HIN 18 MONTHS
-------------�--- _ ._� —
_ ----_ ___ - �, �j ----°—
�on o�cE us� o�t.r \ %t' � t
� i � � 1 i �� ��� `V v� � ��
lill «lIN illlilllllll I II� IIII I I
�E 1 O 8 6 5 2 6 9�4
Request Date: Rough-in inspection Required? ❑ Yes ❑ No Inspection Other Than Raugh-In: Ready Now ❑ Will Call
/ You must cell the inspector when ready! Date Ready:
I cerMy that I am the CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (SVeet , ute No.) � Ciry . Zip Code
^ �J�
Section Township Range Fire No. County ,^ �
� $� "
ipplier Address
Contract r/ Company Name �
, o n i e i�q Installation)
6�9 Coon ids Bivd. NW
r Pertortning Msiallati
13 7/1/2000 BOARD OF E
' S �? - 4�109
Lh•snse
3' 7�� Sa
��������