P - 77684REGlUEST FOR ELECT � AL IJ�� E�JIO�N��f�
1�'3 3 0- 9 2 5 Minnesota Board of Electrici � C�
1821 University Avenue Suite S-128, Saint Paul, Minnesota 551
(651) 642-0800 TTY/MRS 1-800-627-3529 =
www.electricity.state.mn.us
Identify the work covered by this request: �/1� �r_�
i� �, .- C1,_ _ _ F� i-� aa �Y S7�',M
❑NEW ❑REMODEL ❑ADDITION EPAIR
GENERAL FE S
SERVICES / POWER SUPPLIES
0 to 400 Am ere �$25
401 to 800 Am re �$50
Above 800 Am re � $75
CIRCUITS / FEEDEiiS
0 to 200 Amcere � �.5
200 Ampere � $10
)MMUNICATION, REMOTE CONTROL, SIG
CIRCUITS OF LESS THAN 50 VOLTS
ystem Device or Apparatus f� $.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
Center Pivot Irri tion Boom �$40
Manufactured Home Pa�C Lots C� $25
Recreational Vehicle Park Sites � $5
Se arate Bondin Ins ion �$20
Special Inspection � $30 oer Hour
Outdoor Li htin Standard � $1 `
Traffic Si� nal Standard � $5
Su demental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li h6n �$5
ONE & TWO FAMILY DWELIIN�S, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Tri s Each Dwellin Unit �$BC
Additional Inspection Trips � $20
Investiaative Fee
total fee is
I hereby certify that I inspected the electncal installation described herein on the dates
I I Sp�ial Inspection �$.31 per Mile � � �Z�r4'� I
_ THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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R u Date: ' Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-In: Ready Now ❑ Will Call
�,� You must call the inspector when ready! Date Ready: /� j� �'� /aG (j.s
I ceAity that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Addr� (� t.B o��� �� /" � CnY Zip Code
S ��RIOL�' � 3:�
Section Township Ranoe Fira Nn r.,.��.,n�
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EB-00001 - 1/2000
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