P - 78600REQUEST FOR ELECTRICAL INSPECTION
1 3 6 9 9 3 g Minnesota Board of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
- (651) 642-0800 TTY/MRS 1-800-627-3529
� www. electricity. state.mn. us
Identify the work covered by this request: /�� y� r)-'� �' �� � i-�e� �'�
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pNEW ❑REMODEL ADDITION ❑REPAIR 1� <- �^�° ��'-
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES I POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Ampere � $25
401 to 800 Ampere � $50
Above 800 Ampere � $75
�UITS I FEEDERS
0 to 200 Ampere � $5
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CANTROL, SIGI
CUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
�TIFAMILY DWELLINGS (PER UNI'n
3 to 12 Units ��50 Per Unit
Lighling Retro%t � $25 per Fu
Center PNot Irtigation Boom �
Manufactured Home Park Lots
Recreational Vehide Park Sites
Hour
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Suppry for Signs / Outline LigMing �$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 Dwellin Unit �$8f
Additional Ins ection Tri s�$20
Investi tive Fee
Reins eclion Fee � $20
� TOTAL FEI
'�� L�:r/� (minimum total fee is $20
� FOR OFFICE USE ONLY
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that 1 inspected tl�e electrical
herein on tl�e detes stated:
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I certity that I am tl�e ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) Ciry Zip Code
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7/1/2000
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Company or Owner Pertorming in ianon� �
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,c[ y or er Pe ing Installation) Phone �
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� BOARD OF ELEC7RICITY COPY INSTHUC7��NS ON BACK OF YELLOW COPY