P - 78626REQUEST FOR ELECTRICAL INSPECTION
3Q7 Minnesota Board of Electricity '`" `
1� L J 1- 4 6 9 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
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www. electricity. state. mn. us
IdentiTy the work covered by this request
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR ��ON O C� �� d V N� L 1
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPUES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Su temental Fee f� $20
401 to 800 Am re�$50 Trensformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 70 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su for Si ns / Outline U Min �$5
0 to 200 Am ere �$5 , ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re�$10 Includes the Service andlor Power Supply up to 500 Amperes, NI
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelli Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20
Each S stem Device or A aratus �$.50 Invesf tive Fee
ADDITIONS TO THE GENERAL FEES Reins 'on Fee �$20
MULTIFAMIIY DWELLINGS PER UN TOTAL FEE
3 to 12 Units �$50 Per Unit (minimum total fee is $20)
Each Additional Unit � $25 F0" "�TOfl "� °NLV
OTHER ADDITIONAL FEES p�I�s
Li hti Retrofit �$25 r Fxture
CeMer Pivot Irti ation Boom �$40
Manufactured Home Park Lots �$25 I hereb ceAily mat I inspected fhe electricel i�talladon described herein an tlie da�s stated:
Recreational Vehide Park Sif�s � '�" W DA7E
rate Bondin In ion � $20
S ecial Ins 'on � $30 r Hour `a"'` "'�`"�"' � �c °A�
S ial Ins ec6on �$.31 er Mile �� l—��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE I�E ONLY
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Request Da e: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now Will Call
( o�� Z� You must call the inspectw when readyl Date Ready:
I cerGfy that I am the �,IICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the eledrica! work at