P - 819511-1��2-632 ���
Identity the work covered by this request:
❑NEW ❑REMODEL ❑ADDITION ❑REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am ere �$25
401 to 800 Am ere �$50
Above 800 Am re � $75
CIRCUITS / FEEDERS
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity ""�
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us '�` '
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AIARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRGUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
Lighting Retroffi � $25 per Fixture
Center Pivot Irrigation Boom � $4C
Manufactured Home Park Lots � $
Outdoor Li htig ng Standard �$1
Traffic Si nal Standard � $5
Su lemental Fee � $20
Tra�sformers u to t0 KVA �$10
Transformers over 10 KVA � $20
Transfortner / Power Su I for Si ns / OuUine Li htln �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service arxUor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelli Unit �$8C
Additlonal Insoection Trios � $20
Fee �
total fee is
herein on the detes s�ted:
S 'al Ins ection � $� er Hour """""�1°"' / � � �/Q ` I
Special Inspection � $.31 per Mile � /^ � �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF COMPLETED WITHIN 18 MONTHS'
�R OFf10E USE ONLY
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Reques D Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: Ready Now ❑ wll Call �
.1 OI You must caN the inspector when ready! Date Fieady:
I certily that I am the �L�CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
E&OOOOtA-13 7/1/2000 BOAHD OF EIECTRICRY COPY INSTpUC►K1N8 ON BACK OF YELLOW COPY