P - 817411-�5T1-744 E �
Identify ihe work covered by ihis request:
❑ NEW ❑ REMODEL ❑ ADDITION E
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to Am re � $25 :� �
401 to 800 Am re �$50
Above 800 Am re � $75
CIRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Amnere � �10
Center Pivot I
Manufactured
IITS OF LESS THAN 50 VOLT�
Device or Apparatus � $.50
DDITIONS TO THE GENERAL I
IELLINGS (PER UNI�
� $50 Per Unit
31 Unit � $25
OTHER ADDITIONAL FEES
!it � $25 per Fixtute
Park Sites
REQUEST FOR ELECTRICAL INSPECI ,
Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnescta 55104
(651) 642-080C TTY/MRS 1-500-627-3529
www. electricity. state.mn. us �»�
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Traffic Si nal Standard � $5
o, o � Su lemental Fee �$20
Transfortners u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer I Power Su I tor Si ns / Outline Li htin �$5
ONE & TWO FAMtLY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$8(
Additional Ins ection Tri s�$20
lnvestioative Fee
1
(minimum total fee is
N�Y
-� �� �ce�- �n�j
installation described
3o-S„I
Special Inspection @$ 31 per Mile � � � j 7--P1� I
TFiIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFlCE USE ONLY �
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�E 1 D 5 1 7 4 4 9 34
Hequest Date: Rough-in Inspeclion Required? ❑ Yes o Inspeclion Other Than Rough-In: eady Now � WiN Calt
3�� �^ �� You must cali the inspector when ready! Date Ready: 3��O - D�
I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at