P - 79889REGIUEST FOR ELECTRICAL INSPECTION
1� 2 9 5 5 g 4 �� � Minnesota Board of Electricity �
� � 1821 University Avenue Suite S-128, Saint Paui, Minnesota 55104
�a � (651) 642-0800 TTY/MRS 1-800-627-3
www.electricity.state. mn. us
Identity the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR �(, � ,� �J
0 to 400 Ampere � $
401 to 800 Ampere �
Above 800 Ampere �
CUITS / FEEDERS
0 to 200 Amoere � $
ALARM, COMMUNICATION, REMOTE G(
CIRCUITS, CIRCUITS OF LESS THAN 5(
Each stem Oevice or A aratus �
ADDITIONS TO THE GE
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
� S25 oer Fixture
SIGNALING
0
Outdoor LiQhtinq Standard � $t
Traific Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA (� $10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li htln �$5
ONE & TWO FAMILY DWEILINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$81
spe
Additional Inspection Trips � $20
Investiaa6ve Fee
total fee is
011 INSPEGTOq USE ONLY
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herebv certlfv that I insoected the electrical installa5on described herein on the dates
fiecreational Vehicle Park Sftes � $5 ""'"
Se rate Bondin Ins ection �$20
S ial Ins ection �$30 er Hour "�GT10N � ��
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FOR OFFICE USE ONLY
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I certify that I am the
I v�
EB-0OW1A-t3 7(tl2000
CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
BOAND OF ELECTAICTTY COPY
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INSTNUC710N3 ON BACK OF YELLOW COPY