P - 78079C REQUEST FOR ELECTRICAL I����jcT-�f
1—�i•� 9— O� 6 � Minnesota Board of Elecficity ��f
1821 University Avenue Suite S-128, Sairtt Pa innesd� 04
(651) 642-0800 T'fY/MRS 1-800-627-3529 www.electricity.state.mn.us�
❑ NEW ❑ REMODEL ❑ ADDITION REPAIR usmg the back of white cop 'rf n the work covered this request:
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GENERALFEES —
SERVICES I POWER SUPPLIES
0 to 400 Am ere E25 �b � -
401 to 800 Am re E50
Above 800 Am re 575
CIRCUITS / FEEDERS
0 to 2(10 Ampere @ $5
Above 200 Ampere �$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or atus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @ S50 Per Unit
Each Additional Unit � E25
OTHER ADDITIONAL FEES
Li htin Retrofit $.25 er Fixture
Center Pivot I' ation Boom $40
Manufaclured Hane P�k Lots E25
Recreational Vehicle Park Sites � S5 •
� II III II III II III II III II III II III IIBI �� f�
15290265
Outdoor Ligh6ng Standard
Traffic Si9nal Standard O
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, Ali
Circuits and Two Inspection Trips Each Dwelli�g Unit @$80
TOTAL FEE I �
(minimum total fee is $20) �S
THIS AREA Fpi INSPECTqi USE CKY
I hereby cer6ry Mat I inspected the elec6ical installa6on described herein on ttie dates sfaled:
�IIPLETED WITHIN 121
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neques[ ua[e: Rqigh-in Inspection Required? U Yes �Q No Irupection Other Than RougMn: �2eady Now ❑ WGI Call
Q��� D� You must cell tlie inspeUOr wh� ready! Date Ready: �Q � 3'— E} �j
I certify that I am the �LICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the etecLYical work at: