P - 80130~� � REQUEST FOR ELECTRICAL INSPECTION
Minnesata Board of Electricity "�
�, � 3����� g ��° ° 1821 Unl�Jersity Avenue Suite S-128, Saint Paul, Minfl�ota 55104
�� �� (651) 642-OS00 TTY/MRS 1-800-627-3529 �n
www.electricity.state.mn.us ��
IdentiTy the work covered by this request:
❑ NEW REMODEL ❑ ADDITION ❑ REPAIR � �GY � S� � I � ��� g � �
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to S00 Am ere �$50 Transformers u to 10 KVA �$10
Above 890 Am re �$75 Transformers rner 10 KVA �$20
CUITS / FEEDERS Transformer / Power Su i for Si ns / Outline li htin �$5
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, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin UnR �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins 'on Tri �$20
Each S stem Device or A ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinsoec6on Fee �$20
OTHER ADDITIONAL FEES
Manufactured Home Park Lots �
I herebv certiN that I insoecled the eleclrical instelletian
al In ction (� $30 er Hour '""""'"`°'!
al Inspection �$.31 per Mi� �
S INSTALLATION MAY BE ORDERED DISCONNECTE
FOR OFFICE USE ONLY
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total fee is
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WITHIN 18 MON'
5��
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I cer�fy that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspectan oi the eledrical work at .
Job Address (SVeet, Bo,x, Ia Route No.) Ciry Zi Code
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Electric�(3o�pctor /.Gqlr�Qany Name
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Mailing Address ( o� �Br�er � hning InsffiIlation)
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7/1/2000 RD OF ELECTfi1CITY COPY INBiRUCT10NS ON BACK OF YELLOW COPY