P - 77767R�QUEST FOR ELECTRICAL INSPECTION
1� 7 2 9��� O � M,nnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTYlMRS 1-800-627-3529 www.electricity.state.mn.us
0 NEW EMODEL ❑ AD ITION ❑ REPAIR Describe -using the back of the white copy 'rf necessary - the work covered by this request:
�r'11�. �'.�tr��� n,•. l.� l - `-1��- �$ �S �
0 to 400 Am ere 5z5
401 to 800 Am ere E50
Above 800 Am re $75
CI CUITS/FEEDERS
0 to 200 Am re E5
Above 200 Am $1
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or atus E•50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Unifs @$50 Per Unit
Each Additional Unit @ S25
OTHER ADDITIONAL FEES
' htin Retrofit S•25 Fi#ure
Cent� Pivot I' ation Boom E40
Mariufactured Hame Park Lols S25
Recre�onal Vehicle Park Sites LS
Se te Bondin Ins tion $2(1
S ' Ins 'on S3U r Hour
i� Ins 'on 5.37 Mile
THIS INSTALLATION MAY BE ORDERED DISCC
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Su demental Fee $20
Transformers up to 10 KVA $10
Transformers over 10 KVA @$ 20
Transfamer I Power Su for ' ns I Outline Li htin S5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes U�e Service andlor Power Supply up to 500 Amperes, All
CircuiLs and Two Inspection Trips Exh Dwelling Unit @$BO
TOTALFEE -h �
(minimum total fee is $20) p� �
THIS ARFA Fpi MSPECiqt USE qlY
I haeby cer0ly tliaR I inspCCled the ekctrical ins�alafon desaibed herein on tlie dates sta�d:
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72953��U4
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IF NOT COMPLETED WITHIN 12 MONTHS
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