O - 81687REQUEST FOR ELECTRICAL WSPECT{ON
Minnesota Board of Electricity
� �� 4 8���� �� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 7-800-627-3529
. - wwtiv.electricity.state.m.n.us `' '
Identify the work covered by this request: .� ��/
❑ NEW ❑ REMODEL ❑ADDITION REPAIR �
GENERAL FE Outdoor Li htin Standard (� $t
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transfortner I Power Su I for Si ns I Outline Li htin �$5
0 to 200 Am ere �$5 c� ONE & 1W0 FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service and/or Power Suppty 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 l� $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinsoection Fee �$20
OTHER ADDITIONAL
Retrofit � �25 oer Fixture
Inspection � $2i
� $30 per Hour
� $.31 cer Mile
FOR OFFICE I�E ONLY
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tota� fee is $201.�0 • � �
I ir�soected the eledrical instellation described herein an the
I certi(y that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical Nrork at:
Job Address (Street, Box, or Route No.) City � Zip Code
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BOAHD OF ELECTRICRY COPY INS'TRUC7WNS ON BACK OF YELLOW COPY