P - 79578REC�UEST FOR ELECTRICAL INSPECTION
°� Minnesota Board of Electricity '"�
1� 2 5 6-13 2 E°�� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529
� www.electricity.state.mn.us " '
Identify the work covered by this request:
❑NEW ❑REMODEL ❑ADDITION ❑REPAIRG�� G��%'�''" �'"`� I �`
GENERAL FEES Outdoor Li htin Standard �$1 l
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS I FEEDERS Transfortner / Power Su I for Si ns / Outiine Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20
Each S stem Device or A aratus �$: Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FE
3 to 12 Units �$50 Per Unit (minimum total fee is $2
Each Additi0nal Unit �$25 fOfl INSPECTOR USE ONLY
OTHER ADDITIONAL FEES
Li htln Retroffi �$25 er Fature
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots �$25 . I nereby ce ' that I inspected the electr�al installation described herein on the dates �ated:
Recreational Vehicle Park Sttes � "�'�"'" �'�
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S ecial Ins ection �$.31 er Mile �� `"—`�
THIS iNSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 ONTHS
FOR OFFICE USE ONLY
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You must call the inspector when readyl / � Date Ready: � �
I certi(y that I a the �CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route NoJ Ciryl Zip Code
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BOARD OF ELECTAICITY COPY � IN37pUCilONB ON BACK OF YELLOW