P - 81765REQUEST FOR ELECTRICAL INSPECTION
1� �3'"J l7 - 5 6 7 � Minnesota �ard of Electricity
�"�` 1821 Universi Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
� www.electricity.state.mn.us
Identify the work covered by this requesi: , __
❑NEW ❑REMODEL ❑ADDITION O PAIR �
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Tratfic Si nal Standard �$5
0 to 400 Ampere �$25 Su lemental Fee �$20
401 to 800 Am re �$50 7ransformers u to 10 KVA �$10
Above 800 Am re�$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns I Outline Li htin �$5
0 to 200 Am ere �$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor 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 Addftional Ins ection Tri s�$20
Each S stem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAI FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$50 Per Unit (minimum total fee is $20)
Each Additional Unit �$25 FOP INSPECTOfi IA4E ONLY
Li htin Retrofit �$25 r Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots �$25 I he ' tliat I inspec[ed the eleclrical instaila6on described herein an the
fiecreational Vehicle Park Sites �$5 A[1 a� . "0U�'"
ep cial Inspection �$.31 per Mile � �
PHIS INSTALLATION MAY BE ORDERED DISCONNECTED
�—P1
NONTHS
I cerGiy that 1 am the
Occupant �
Power Supplier
Electrical Contrec[ / Cor
DEPENDABLE
M � � Cmtr
Caon Rapids. I
�(CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
or Route No.) City Zip Code
LJ
Range Fire No. County
Phone '/'/'/
la.! , � D/I '%/ � ' �S"7/— � �/�/Y
Name
55433
, Company or
Phone
.� .S lS / J �7U
EB-00001 A•13 /7I2000 BOARD OF ELEC7AICITY COPY IN$iAUCT10NS ON BACK OF YELLOW COPY