P - 75780/� REQUEST FOR ELECTRICAL INSPECTION
1� 9 5 9���$ �� Minnesota Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 551 U4
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(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
D - irig thg,back e white co 'rf ne�,e� - th rk cove by this request:
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ENERAL FEES Outdoor LiaMina Standard (o� �1
SERVICES / POWER SUPPLIES
0 to 400 Ampere $25
401 to 800 Am re $50
Above 800 Am re $75
IRCURS/FEEDERS
0 to 200 Am re$5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNAL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each m Davice or Ap ratus @$.50
ADDffIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS ER UN
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Li hting Retroftt @$25 per Focture
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CeMer Pivot Irri ation Boom @$40
Manufactu�ed Home Park Lots $25
Recteatlonal Vehicle Park Sites $5
Se Bondin Ins 'on $20
Special Insp�tion @ $30 {�r Hour
S' I Inspedion @$.31 r Mile
THIS INSTALLATION MAY BE ORDERED
I lfll II I� � I� II I� I� �I II �I � I� II �I D� I�
19597483
E1"FR'F?i!I
ONE 6 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspe�fion Trips Each Dwa�ing Unit @$BO
Additional Ir�saectlon Trias C� $20
( TOTAL FEE I �� •
minimum total fee is $20
nus a�a wR u�crat usE onar
I hereby certJy thet I ir�speded fhe el�icel insfallatlon desc�ibed here
dates stated:
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F NOT COMPLETED WITHIN 12 MONTHS ^�
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"""'' % Rough-in Inspectlon Required? ❑ Yes � I�pectlon Other Than
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You must call the inspector when readyl Date Ready.
I cer6fy that I am th CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby r
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ady Now ❑YViII Call
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of th� el�trical work at
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�NSTRUCTIONS ON BACK OF YELLOW COPY BOARD OF ELECTRICT' Cl1W �e nnnn. � a c e.