P - 79842REQUEST FOR ELECTRICAL INSPECTION .�
Minnesota Board of Electricity ��`�
1�� 9 7• p g 5� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� , (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us �' �
Identity the work covered by this request: ^ �
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIFt�J V,�.
GENERAL FEES Outdoor Li Standard �$t
SERVICES i POWER SUPPLIES Tratfic Si n Standard �$5
0 to 400 Am ere �$25 Su lemental Fee @$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above S00 Am ere �$75 Trensformers over 10 KVA �$20
CUITS I FEEDERS Transformer 1 Power Su I for Si ns I Outline Li htln �$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, COMMUNIGATION, REMOTE CONTROL, SIGNALING Circufts and Two Inspection Trips Each Dweilin Unit �$80
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIf
Liahtinq Retrofit � $25 per Fixtu
Center Pivot Irrigation Boom � $
Manufactured Home Park Lots �
Recreational Vehicle Patk Sites �
Fee
KH � 300��
I herebY certittY that I inspected the eleGrical installsibn a
total fee is
ai the
S ial lns ection �$30 r Hour '""`"'��
S ial Ins 'on �$.31 r Mile � 7 ��' �
_ Twe �t,�eTe� t eT1oN MAY BE ORDERED DISCONNECTED IF MPLETED WITHIN 18 MQNTHS
FOR OFFICE USE ONLY
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equ Date: J�� Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now �II Call
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�-� You must call the inspector when ready! Date Ready: -
I certiTy that I am the ENSED CO TRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical xrork at:
Job Address (Stre Box or Ro o.) Ci >
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BOARD OF ElEC7AICRY COPY
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